Explore the key events that transformed healthcare services in four areas: Mental health, Reproductive health, Screening and Palliative care.
Transforming healthcare services
Select from the images below to explore the key events that transformed healthcare services.
Transforming reproductive health
A brief history of reproductive health
The range of innovations that have impacted on reproductive health over the last few decades are far-reaching and wide-ranging. Alongside these developments, the role of midwives has changed. While they still act as independent practitioners involved in normal birth, their job is now one in which a high level of clinical expertise is needed. This professional status has been eroded by the shift from home to hospital birth where the medical profession continues to dominate the terrain, and medical technology has changed all aspects of reproductive health.
Legal registration and recognition of midwifery profession
Midwives care for women in the antenatal, intrapartum (birth) and post-natal period and for up to 28 days after the birth.
First special care baby units established in Britain for the specialist care of pre-term and sick babies.
Contraceptive birth pill approved by the FDA in America
Access to safe contraception dramatically changed the role of women in society who were freed from childbirth and able to plan their pregnancies.
Vasectomy became available to men on the NHS and offered a ‘permanent’ and much safer voluntary sterilisation than female sterilisation in that the procedure was quicker and carried less risk. Techniques to reverse sterilisation have developed which have had varying success.
The Abortion Act
The Abortion Act made it legal to terminate a pregnancy beyond previously restricted medical grounds. In 2011, just under 190,000 abortions were carried out in England and Wales, of which 91% were performed at less than 13 weeks gestation and, of all abortions, just under 1% were because of the risk of ‘handicap’ to the child.
The first baby was born from in-vitro fertilisation (IVF)
IVF involves an entire system of specialist care, including drug treatments, monitoring of ovulation using an ultrasound scanner, obstetric, technical and counselling support in assisted conception units. The number of cycles of treatment available on the NHS is restricted.
Hospital versus home birth
The number of hospital births rises to 90% despite poor evidence to suggest that home births were less safe. The role of the midwife as a practitioner of normal birth was being eroded.
First trials of the drug Surfactant began which would reduce the surface tension in the lungs of pre-term infants and allow for better air flow to their lungs and significantly reduce the high death rate from respiratory distress syndrome (RDS). Prior to the availability of Surfactant, RDS was the commonest cause of death in pre-term infants.
Surrogacy was reviewed by health ministers who considered the legal and financial implications for women who agree to carry a baby for a couple. The surrogate mother might be the genetic mother and use insemination or might carry the foetus following IVF which might partly or totally belong to the adopting parents. Surrogate mothers are not allowed a fee for this service but should not be out of pocket. Over 15 years later, surrogates will be paid usually between £7,000 and £15,000 by the adopting parents.
The Caesarean section rate rises from 9% to just under 25% in Britain with no obvious clinical justification and no obvious improved outcomes for babies. Women in hospital were more likely to be monitored for risks and instrumental interventions made to prevent perceived risks to mother and baby. Childbirth has become normal in retrospect.
Transforming mental health
A brief history of mental health
Mental health and illness are subjects that many people feel uncomfortable talking about. In the past people with severe mental health problems were locked away out of sight and ‘out of mind’ in large asylums where there was very little to offer in terms of treatment. Modern advances in pharmaceuticals and psychological therapies combined with a change in attitudes in society, have led to most people with mental health problems being cared for in the community.
Since the formation of the NHS in 1948 there have been a number of developments in the treatment of mental health problems, not least the establishment of community-based mental health teams made up of psychiatrists, psychologists, counsellors, mental health nurses, social workers, occupational therapists and others who offer a range of support and treatment options to their clients.
'Bedlam' - the first UK asylum
Bedlam, the first public asylum which had been treating insanity since the 14th Century, opened a purpose-built hospital in London. The institution still exists today, on a different site, as the Bethlem Royal Hospital.
Victorian asylums each housed many hundreds of inmates
This year saw the formation of the Association of Medical Superintendents in the UK. Medical superintendents ran the mental asylums and were the forerunners of today’s psychiatrists.
'Shell-shock' raised awareness of nervous disorders
The return of soldiers with ‘shell-shock’ from the battle fields of WW1 raised the awareness of ‘nervous disorders’ amongst medical practitioners who had previously been largely concerned with psychotic disorders.
Electro convulsive therapy a controversial treatment
The first use of Electro Convulsive Therapy in Italy, from where it soon spread to other countries including the UK. The use of ECT has been contested for many years with some patients regarding it as helpful and others seeing it a barbaric.
The introduction of Chlorpromazine
Chlorpromazine’s anti-psychotic properties were discovered and this drug was rapidly deployed during the decade drastically reducing the need for sedation and physical restraint in mental hospitals.
Enoch Powell, Minister of State for Health
Health minister Enoch Powell’s speech about his hospital plan signalled the changes ahead that would eventually lead to the closure of the large Victorian asylums.
Diazepam or ‘Valium’ introduced
The tranquilliser diazepam (Valium) was introduced and went on to be prescribed in very large numbers in the following decades.
Closure of the asylums
The closure of the old long-stay asylums was accompanied by fears that the alternative of ‘care in the community’ was not well enough developed. This period also saw a growing service user movement in the UK with demands for civil rights and greater choice of treatments.
Community-based mental health teams
There was a growing trend to base mental health treatment facilities in the community. Community mental health teams were created where psychiatrist, psychologists, mental health nurses, social workers, occupational therapists and other professionals were brought together to provide services outside of hospital settings.
Funding of new psychological therapy services
The NHS launched the Improving Access to Psychological Therapies project which aims to make the provision of talking treatments (particularly Cognitive Behavioural Therapy) much more widely available by funding the training of many new practitioners linked to local health centres.
Transforming end-of-life care
A brief history of end-of-life care
The medical model of health positioned death as a failure and end-of-life care was often associated with the words ‘nothing more can be done’. Immediately after the Second World War, Dame Cicely Saunders revolutionised the approach to palliative care by placing the dying person at the centre of all decisions and using a model of ‘total pain’ in which all aspects of care were addressed, including physical pain, emotional distress, spiritual distress and social pain.
This approach saw the advent of the hospice movement. The focus was on cancer and other conditions continued to be relatively neglected. The hospice movement has expanded its reach to include all forms of dying with the special needs of children and, more recently, babies being included. The change in NHS funding has resulted in a consultation to develop a tariff on end-of-life care which jeopardises all non-clinical elements which are not eligible for NHS funding.
The Marie Curie Cancer Care memorial foundation begins
The foundation now provides care to patients and families through nursing services and hospices.
The concept of total pain is established
This concept is based on the way in which a dying person’s symptoms impact on their physical, emotional, spiritual and social wellbeing.
St Christopher’s Hospice is set up in London
This became one of the most important places for education and research in palliative and terminal care.
First Hospice at Home services available
Hospice at Home services were established to provide excellent end-of-life care to people at home.
First children’s hospice is opened
The first children's hospice was Helen House in Oxford, England. More long-term interventions are used to sustain children’s lives and so hospices offer respite care, help and advice and crisis intervention as well as end-of-life care.
Challenging the focus on cancer care
This decade and onwards has seen an increase in the survival rates and lengths of survival from cancer began to challenge the appropriateness of the (adult) hospice focus on cancer care.
During this decade there was an increased focus on patient power and autonomy. This led to an interest in the ability for individuals to make advance plans, allowing for the refusal of treatment near the end of life.
The first Britain dies at Dignitas
The first Britain died at Dignitas in Switzerland following a lethal drink in an act of assisted suicide. He was the first of 180 Britons to die there. Cicely Saunders - by now a Dame - argued that care not killing would end the demand for such death.
Access to end-of-life care for all
The NHS end-of-life care programme was established to provide access to end-of-life care to all people who need it and in all settings.
Palliative Care Funding Review launched by government
The Palliative Care Funding Review launched by the government to propose a funding mechanism that would work for commissioners of health care.
A brief introduction to screening
Screening for health problems occurs throughout the life-course. Whether it is for a newborn baby or an older person, every day there will be many people anxiously awaiting the results of screening tests. The NHS puts a lot of resources into screening programmes and the results can save many lives. Although some people might rather not know if they have any, as yet undetected, health problems others would rather find out early on in case they can do something about it.
Screening newly born babies can identify problems that can be remedied early on that otherwise would affect them for the rest of their lives. Adults can be alerted to health problems that, although they are not currently aware of any symptoms, could become life-threatening if preventative measures are not taken.
Screening in the NHS
The NHS offers screening right from the point at which someone is considering becoming pregnant, through pregnancy itself and then immediately after birth for the newborn baby. Screening carries on though childhood, during adulthood and into old age.
The NHS provides genetic testing to detect people who are carriers of particular mutations in genes which then pose a risk of potential offspring developing a particular genetic condition. Cystic fibrosis, sickle cell anaemia and thalassemia are such conditions and people found to be carriers can be offered genetic counselling so they can make informed choices about whether or not to attempt pregnancy.
Screening in pregnancy
In England in 2011/12 roughly 5 million screening tests were carried out on pregnant women. Over 675,000 were tested for HIV and rubella. More than 540,000 were screened for the possibility of the baby having Down’s syndrome and 17,314 were identified as being at risk.
In England in 2011/12 around 4.75 million tests were carried out on newborn babies. Nearly 700,000 babies were screened and 1,294 were found to have a serious health condition. Babies are routinely screened for problems with hearing, eyes and hips and a blood spot test is used to check for various diseases.
Screening for infectious diseases
At one time tuberculosis used to be a widespread disease in the UK and practically every school child was tested for it. More recently HIV/AIDs became a concern and, although mass screening has not been adopted, at risk groups, such as injecting drug users and gay men, have been targeted for screening programmes.
Diabetes detection through ocular tests
Diabetes affects many people in the UK, but in the early stages they are unlikely to be aware of it. Opticians can detect signs of diabetes by a visual examination of the retina; in England in 2011/12 about 1.9 million tests were conducted for diabetic eye disease.
Women’s health: breast and cervical cancer
In 2010/11 over 2.8 million women aged 45-74 in the UK were offered breast cancer screening and 73% took up this offer. In 2011/12 over 3.5 million women had cervical smear tests and just over 37,000 had results that suggested cause for concern and referral for further tests.
Screening for heart disease
High blood pressure and high levels of cholesterol in the blood can exist without the person concerned feeling any symptoms. However, these factors increase the risk of heart disease and stroke. Through screening programmes individuals at risk can be identified and encouraged to change relevant lifestyle factors and where necessary be put on medication to lower their blood pressure and cholesterol levels.
Most people over the age of 60 will be offered screening for bowel cancer. Around 110 people are diagnosed with bowel cancer every day in the UK and early diagnosis and treatment makes a significant impact on the chances of survival.
Screening, although positive for health, also raises ethical questions particularly as scientific advances make it possible to gather and interpret more and more information. Screening could influence who should be discouraged from having children and predictions of future health problems could have a serious impact on the ability to get life insurance – who will decide on the limits of screening in the future?
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This feature was created to support the new BBC Two series Keeping Britain Alive: The NHS in a Day.
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