While the skeleton of public access to health services was beginning to emerge during this period - with workhouses, voluntary hospitals, asylums and isolation hospitals - the level and conditions of care were poor.

At the beginning of the century, preventative healthcare measures became a focus of attention since both the Boer and Crimean wars had highlighted the poor health of soldiers; more had died from fevers and typhoid than through actual warfare.

Any treatment received by wage earners tended to be paid for by their subscriptions to trade unions or friendly societies who, in turn, paid the doctors. This system, however, only covered the worker and not the family. Those who couldn’t afford to pay relied on out-patient departments and dispensaries at local voluntary hospitals or simply did not receive treatment.

Towards the end of the 19th century, voluntary hospitals, unable to provide services on charitable donations alone, began charging for hospital costs.

In 1905, the Minority Report of the Poor Law Commission pointed out the differences in standards of health care services provided across the country and urged the government to make amends. It responded with benefits for the unemployed and pensions for the elderly rather than a direct approach.