Topic 5 (Developments in patient care)

• What was an infirmary?


  Type of hospital ward for sick patients

  separated from the rest of the monastery to stop infection spreading
• What did the christian church begin to set up in the 12th century?

  hospitals run by monks and nuns

  They were called ‘hospitals‘ because they offered hospitality providing shelter to travellers and pilgrim, or a place for elderly people to stay, or a place for lepers to shut themselves away

  only a small number of these hospitals cared for the sick

  There were no doctors within these hospitals

  Monks would pray for the souls of the patients while the nuns looked after the welfare of the patients and administered herbal remedies
• Welsh monasteries


  The Cistercians built monasteries in Valle Crucis, Basingwerk, Aberconwy, Strata Florida,
• Welsh Friaries


  The Franciscans built friaries at Bangor, Brecon, Cardiff, Denbigh, Haverfodwest,
• What did the Knights of St John of the order of Hospitaller build?

  A hospital at ysbyty Ifan to care for pilgrims
• Why were many hospitals closed in the 1530’s?

  Henry VIII dissolution of the monasteries
• Hospital closures 


  Hospitals taken on by voluntary charities

  Towns and councils took over

  In London 5 major hospitals were endowed with royal funds during the mid 16th century to care for the sick and poor (St Bartholomew’s hospital serving the poor and St Mary Bethlehem which concentrated upon looking after the mentally insan)
• How was the demand for increased hospital provision met in the 18th century?

  Financial donations from new wealthy industrialists

  For example, Thomas Guy a wealthy printer and bookseller who financed the establishment of Guys Hospital in 1724

  11 new hospitals were founded in London and a further 46 in industrial towns and cities, (including Westminster Hospital in London, Addenbrooke’s Hospital in Cambridge and the Royal Infirmary Hospitals in Edinburgh and Manchester
• Establishments of Voluntary hospitals across Wales

  1807 - Denbigh General Dispensary and Asylum for the Recovery of Health opened

  1817 - Swansea established an infirmary

  1833 - Wrexham established a dispensary

  1838 - Wrexham established an infirmary

  1837 - The Glamorgan and Monmouth Infirmary and Dispensary was opened in Cardiff

  1839 - Newport set up a dispensary
• Establishments of voluntary hospitals across Wales 2

  Volunteer hospitals established in Aberdare (1881) Merthyr Tydfil (1887) and Bridgend (1895)

  Stanley Sailors Hospital - In Holyhead and opened in 1861 to treat sick sailors and paid by Philanthropist, William Owen Stanley of Penrhos (taken over by NHS in 1948)

  Royal Hamadryad Hospital - in Cardiff, opened in 1866 and used to treat sick sailors and stop infectious diseases such as cholera and smallpox from entering the town (replaced by permanent structure in 1905 and continued in use until 1948)
• Development of endowed hospitals in late 18th century

  Turning point in development of the hospital

  evolved from being a place of basic care to becoming a centre in which to treat illness and conditions that required surgery

  Patients were washed, kept warm and fed regularly

  Nursing sisters were able to treat patients with herbal remedies

  simple surgery’s, like removal of bladder stones and setting broken bones were carried out by physicians

  Treatment was normally free
• Why was the quality of nursing poor?

  lack of training and medical knowledge
• Florence Nightingale


  Nightingale secured funds from the government to send herself to Russia to help treat soldiers in the Crimean War

  She found that there were 1,700 patients in the field hospital (many suffering from cholera and typhoid, housed in filthy wards)

  First task was to clean the wards (patients were washed regularly, given clean clothes and had their bedding changed often

  To prevent the spread of disease, patients were separated according to their illness.

  This led to the death rate dropping by 2%
• Florence Nightingale returned to England


  1856
• Florence Nightingale's campaign to reform army medical services

  1. Called for purpose built hospitals

  2. Trained nurses

  3. Clean floors

  4. Plenty of light

  5. Fresh air

  6. Better food
• Florence Nightingale published her notes on nursing


  1859
• Florence Nightingale fund


  Set up by The Times, raised £50,000
• Used the £50,000 to set up training schools for nurses at St Thomas's Hospital and Kings College Hospital (training based on her principles of patient care)

  1860
• Hospitals


  • Royal Liverpool Infirmary were built to her designs
• By 1900, nursing had become a recognised profession
• Betsi Cadwaladr


  1854 - she went to the Crimea to help nurse wounded soldiers

  She found it difficult to follow the strict regime of Nightingale and left Scutari for a hospital at Balaclava

  She worked long hours treating the wounded and nursing the sick

  She caught cholera and dysentery in 1855, causing her to leave the Crimea

  The Betsi Cadwaladr NHS trust in North Wales commemorates her
• What was the policy of Laussez-faire?


  the belief that it was not the governments to interfere with people’s lives unless they really had to
• Liberal reforms 


  The liberal government introduced a series of welfare reforms designed to help people who fell into difficulty through sickness, old age or unemployment

  the reforms tackled provision of education , the medical inspection of school pupils, free school meals, worker’s compensation rights and the provision of old age pensions
• Impact of the liberal welfare reforms

  Medical inspections were introduced in 1907, but poor families couldn’t afford to pay for necessary treatment

  pensions introduced for over 70s but only if you had worked all your life and could prove you were not a drunkard

  average age of death was 50

  National insurance scheme only applied if you paid regular contributions
• What laid down the first steps of creating a welfare state?

  National Insurance Act of 1911

  Involved workers and employees making weekly contributions into a central fund used to give workers sickness benefit and free medical care

  The scheme was restricted to certain trades and it didn’t cover wifes, children, unemployed, elderly, mentally ill and chronically ill
• Beveridge report?


  published by William Beveridge in 1942 and aimed to tackle the five giants

  disease was one of the five giants

  Aneurin Bevan was Minister of Health in 1945 and introduced a free national health service

  National health service act passed in 1946

  NHS began it’s practice on the 5th of July 1948
• Impact of NHS


  In 1947 7 million prescriptions issued per months

  By 1949 8.5 million people had received free dental treatment