The Birth of the NHS
by Jessica Brain
70 years ago, on the 5th July 1948 an historic moment occurred in British history, a culmination of a bold and pioneering plan to make healthcare no longer exclusive to those who could afford it but to make it accessible to everyone. The NHS was born.
The National Health Service, abbreviated to NHS, was launched by the then Minister of Health in Attlee’s post-war government, Aneurin Bevan, at the Park Hospital in Manchester. The motivation to provide a good, strong and reliable healthcare to all was finally taking its first tentative steps.
The creation of the NHS in 1948 was the product of years of hard work and a motivation from various figures who felt the current healthcare system was insufficient and needed to be revolutionised.
Aneurin Bevan, Minister of Health, on the first day of the National Health Service, 5 July 1948 at Park Hospital, Davyhulme, near Manchester. Licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license.
These ideas can be traced back to the early 1900s with the Minority Report of the Royal Commission on the Poor Law in 1909. The report was headed by the socialist Beatrice Webb who argued that a new system was needed to replace the antiquated ideas of the Poor Law which was still in existence from the times of the workhouses in the Victorian era. Those who were involved in the report believed it was a narrow-minded approach from those in charge to expect those in poverty to be entirely accountable for themselves. Despite the strong arguments provided in the report, it still proved unsuccessful and many ideas were disregarded by the new Liberal government.
Nevertheless, more and more people were beginning to speak out and be proactive, including Dr Benjamin Moore, a Liverpool physician who had great foresight and a pioneering vision of the future in healthcare. His ideas were written in “The Dawn of the Health Age” and he was probably one of the first to use the phrase ‘National Health Service’. His ideas led him to create the State Medical Service Association which held its first meeting in 1912. It would be another thirty years before his ideas would feature in the Beveridge Plan for the NHS.
Before the creation of the NHS or anything like it, when someone found themselves needing a doctor or to use medical facilities, patients were generally expected to pay for those treatments. In some cases local authorities ran hospitals for the local ratepayers, an approach originating with the Poor Law. By 1929 the Local Government Act amounted to local authorities running services which provided medical treatment for everyone. On 1st April 1930 the London County Council then took over responsibility for around 140 hospitals, medical schools and other institutions after the abolition of the Metropolitan Asylums Board. By the time the Second World War broke out, the London Council was running the largest public service of its kind for healthcare.
Scene from ‘The Citadel’ (1938)
Further momentum was gained when Dr. A.J Cronin’s novel “The Citadel” was published in 1937 and proved to be highly controversial for its criticism of the inadequacies and failures of healthcare. The book was based on a story about a doctor from a small Welsh mining village who climbed the ranks to become a doctor in London. Cronin had observed the medical scene greatly and the book prompted new ideas about medicine and ethics, inspiring to some extent the NHS and the ideas behind it.
There was a growing consensus that the current system of health insurance should be extended to include dependents of wage-earners and that voluntary hospitals should be integrated. These discussions were not taken any further when in 1939 the outbreak of the Second World War took precedence. The wartime period necessitated the creation of the Emergency Hospital Service to care for the wounded, making these services dependent on the government. The issue of health provisions in Britain was a growing problem.
By 1941, the Ministry of Health was in the process of agreeing a post-war health policy with the aim that services would be available to the entire general public. A year later the Beveridge Report put forward a recommendation for “comprehensive health and rehabilitation services” and was supported across the House of Commons by all parties. Eventually, the Cabinet endorsed the White Paper put forward by the Minister of Health Henry Willink in 1944, which set out the guidelines for the NHS. The principles included how it would be funded from general taxation and not national insurance. Everyone was entitled to treatment including visitors to the country and it would be provided free at the point of delivery. These ideas were taken on by the next Health Minister Aneurin Bevan.
The nuts and bolts of the project finally took hold when Clement Attlee came to power in 1945 and Aneurin Bevan became Health Minister. It was Bevan who embarked on the campaign to bring about the NHS in the form we are now familiar with. This project was said to be based on three ideas which Bevan expressed in the launch on 5th July 1948. These essential values were, firstly, that the services helped everyone; secondly, healthcare was free and finally, that care would be provided based on need rather than ability to pay.
Since then, the NHS has gone through many changes, improvements, updates and modernisation processes. No-one back in 1948 would have been able to foresee the way in which the NHS developed, succeeded, pioneered and expanded.
In the early years of the NHS, not long after its launch, expenditure was already exceeding previous expectations and charges were considered for prescriptions to meet the rising costs. By the time of the 1960s these early adjustments were altered and it was considered to be a strong period of growth for the NHS, characterised by new developments in the availability of drugs.
As the years rolled by, new changes were made and reorganisation occurred in 1974 as the period of economic optimism which had characterised the earlier decade was beginning to wane. By the time of the 1980s and the Thatcher government, modern methods of management were introduced. However the necessity for the NHS to remain as a critical mainstay service for the British public was prioritised still by Margaret Thatcher, despite the conflict in ideas in other areas such as welfare and public housing.
Today, the NHS is facing a greater crisis still. The issues of funding and demand continue to rise and the ability to provide free healthcare to all is a continuous topic of debate for many.
Nevertheless, seventy years marks an important moment in British history. The NHS created in 1948 was brought about through hard work and dedication from those that truly believed in new ideas about services, health, medical ethics and society more generally. The NHS has faced crisis, economic downturns, periods of prosperity, growth and so much more in its seventy years of operation.
The NHS has in some ways exceeded expectations and at the same time there is always more that can be done. The idea of a National Health Service once upon a time would have been unheard of, yet today we cannot imagine life without it. The creation of the NHS marks a significant chapter in British social history.
Jessica Brain is a freelance writer specialising in history. Based in Kent and a lover of all things historical.