The Cabinet Papers banner

Origins of the NHS

A mobile exhibition van is used to attract potential nursing recruits in 1948.
A mobile exhibition van is used to attract potential nursing recruits in 1948.
©TopFoto

To some extent the Second World War changed peoples attitudes. The need to treat large numbers of civilian casualties from bombing raids gave people access to health care they had never experienced before. The state had also controlled almost every aspect of people's lives during the conflict, so the idea of government looking after citizens' health did not seem strange. Government ministers noticed that as a result of rationing, the health of the poor had actually improved.

Post-war consensus

In the years immediately after the Second World War there was a period in British politics now known as the 'post-war consensus'. Historians use this term because for the most part, the major political parties agreed on the country's main priorities and generally co-operated in trying to achieve them. Top of the list was post-war recovery, but another priority was the welfare of the people, directly involving the National Health Service (NHS).

Another reason why there was comparatively little political dispute over the welfare programme of 1945-1951 was that political dissent would have had little effect due to the huge majority the Labour government held in parliament.

The Beveridge report

The Beveridge Report of 1943 set out plans for the future of post-war Britain. It identified the main issues facing British society, including disease, and laid the foundations of what would become known as the Welfare State. When Labour came to power in 1945, an extensive programme of welfare measures followed - including a National Health Service (NHS). The Minister of Health, Aneurin Bevan, was given the task of introducing the service.  

Until now health care in Britain had been founded on insurance-based schemes as most people could not afford to pay for medical bills. The National Health Service (NHS) changed this, and medical care became free and based on need rather than on ability to pay. It was 100 per cent financed from taxation, which meant the rich contributed more than the poor. Everyone was eligible for treatment, even foreigners living temporarily in Britain, and treatment could be given at any NHS institution anywhere in the country.

Structure

The National Health Service (NHS) was planned as a three-tier, or tripartite, structure. At the top was the Minister of Health and below were the three tiers designed to interact with each other to suit the needs of the patient. 

  • Hospitals: The voluntary (charity or church run) hospitals and the municipal hospitals were nationalised and organised into regional groups. Organisation was based upon 14 Regional Hospital Boards. These boards supervised local hospital management committees; doctors in hospitals would receive salaries, and all treatment was to be free. Teaching hospitals were to be directly controlled by the Minister of Health, as Bevan believed that these hospitals should serve the whole country rather than just the area they were in.
  • Family doctors, dentists, opticians and pharmacists: Self-employed professionals had a contract with the National Health Service (NHS) to provide services so that patients did not pay directly. The family doctor, or General Practitioner (GP), was the point of contact for most patients. The GP could treat patients or refer them to other parts of the NHS for specialised care. Opticians provided eye tests and spectacles once a GP had referred the patient to them. Pharmacists provided over the counter remedies, and dispensed the GPs' prescriptions.
  • Local authority health services: Community clinics provided services such as immunisation, maternity care and school medical services, and were controlled by a local authority Medical Health Officer.

Demand

1949 child patients at Braintree Hospital in Essex are lined up for school lessons.
In 1949 child patients at Braintree Hospital in Essex are lined up for school lessons.
©TopFoto

Demand for health care under the new National Health Service (NHS) exceeded all predictions. The number of patients on doctors' registers rose to 30 million. The NHS budgeted for one million pounds for opticians, but within a year 5.25 million spectacle prescriptions (and other work) had produced a bill totalling 32 million pounds. In 1947 doctors issued 7 million prescriptions per month, which rose to 19 million per month in 1951.

The poor gained access to doctors and a range of treatments previously beyond their means, and no longer needed to worry economically about illness or injury. But it was not only the poor who benefited, as the middle classes also made full use of the NHS. In the first year, from a total of 240,000 hospital beds, only 2.5 per cent were private, and over 95 per cent of doctors joined the NHS.

Opposition to the NHS

Despite the apparent consensus, opposition to the establishment of the National Health Service (NHS) existed. Many groups, including charities, churches and local authorities didn't want the government taking control of hospitals. There was a particularly bitter battle with the London County Council over the control of hospitals in the capital.

Even more serious was the opposition of doctors who disliked the idea of becoming employees of the state. Doctors were in an extremely powerful position, as without them the National Health Service (NHS) could not operate, and the government was forced to make a number of compromises. General Practitioner (GP) surgeries remained private businesses that could be bought and sold, and the NHS effectively gave these practices contracts to provide health care. Only the most senior doctors in hospitals (consultants) were allowed to continue private treatment. Similar compromises were worked out with dentists. Aneurin Bevan conceded these points in order to make the NHS work, but he was not happy with them.

Expansion and improvements

1950s X-ray examination.
In the 1950s X-ray examinations are a routine feature of the expanding service.
©TopFoto

From the 1950s onwards the scale and quality of the treatment provided by the National Health Service (NHS) improved, and between 1948 and 1973 the number of doctors doubled. Anaesthetics continued to advance, enabling longer and more complex surgery. The NHS improved the lives of millions with hip replacement operations, emergency treatment for accident victims and fertility treatment for childless couples. Programmes of vaccination protected children from whooping cough, measles, tuberculosis and diphtheria. New technology enabled brain and whole body scans, and advances were made in the care of the mentally ill. Even cosmetic surgery became available on the NHS.

Prevention

The National Health Service (NHS) has played an important part in prevention as well as cure. By the mid-1960s governments were investing in health education with campaigns warning people about the dangers of smoking and alcohol, and encouraging people to eat more healthily. There were also strenuous campaigns to encourage people to take more exercise, although these had mixed success.