the history of the nhs assignment

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NHS History

Milestones of the nhs.

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The foundation of the NHS

On 5 July 1948, just three years after a ruinous total war, Britain's National Health Service (NHS) opened. It's now one of the most well-known and loved institutions in the country. But even months before it launched, its existence was not secure, as seen from documents at The National Archives.

A September 1948 pamphlet cautioning the public to ‘not expect miracles’ and behave sensibly after the NHS was established. Catalogue reference: MH 55/965

The Beveridge Report

Prior to the Second World War, some in Britain could not afford medical care. Sickness benefits and other forms of insurance existed but illness could impoverish a family.

During the war, the economist and former director of the London School of Economics, Sir William Beveridge was commissioned by the Wartime Government to write a report into how to alleviate these social problems. The Beveridge Report released in November 1942, planned to remake Britain after the war by setting up a comprehensive benefits system to end ‘Want’. Underlying this, Beveridge said, would have to be free healthcare. The report – an original copy sent to Prime Minister Winston Churchill is available to view at The National Archives – was hugely influential on the post-Second World War recovery in Britain.

Contents page from William Beveridge's Social Insurance and Allied Services report, showing 'comprehensive health and rehabilitation services' as one of the three assumptions in planning for the post-war abolition of 'Want'.

Catalogue reference: PREM 4/89/2

With most of the population in favour of Beveridge’s conclusions on free healthcare, the government promised a post-war National Health Service in a 1944 white paper . But while everyone agreed on the aim of universal healthcare, the government cautioned that opinions on ‘the method of achieving it’, were divided.

'Here is our chance to do something big'

Not least was the problem of doctors. Aneurin ‘Nye’ Bevan became Minister of Health after Labour’s 1945 election victory. Born in Tredegar, Wales, at the age of 47 the former miner was the youngest MP in Clement Attlee’s 1945 Cabinet and one of the most left-wing. He was convinced that the service had to be centralised and doctors state employees, rather than the private businesses they were before.

Many doctors, and the British Medical Association (BMA) which represented them, were unhappy with this, saying they might refuse to participate in the NHS. In December 1945, some of Bevan’s Cabinet colleagues suggested that this might delay the NHS’s launch. Bevan was defiant, he would simply ‘squeeze them out’ with better NHS services. Cabinet meeting minutes held at the National Archives note that Bevan told his colleagues ‘Here is our chance to do something big’.

But the BMA didn’t back down either. In January 1948, just six months prior to the NHS’s publicised launch, they described the service as, ‘so grossly at variance with the essential principles of our profession that it should be rejected absolutely by all practitioners’.

This was, ‘an attempt not merely to seek detailed improvements … but to completely sabotage it’, said Bevan in a government correspondence . Bevan believed attack was the best form of defence. If he could not win over the BMA, he would ‘build up accumulating evidence in the Press and elsewhere’ to win over the public. Bevan called this ‘explanatory work’.

Explaining the NHS

The short cartoon, ‘Your Very Good Health’ , released in early 1948 by the Central Office of Information (COI), was part of Bevan’s ‘explanatory work’. It stars ‘Charley’, an everyman. Charley is initially sceptical of the NHS. He has sickness insurance, and while his wife does not, “she’s as strong as a blooming horse she is!”. But soon, after the narrators has shown him the true costs of hypothetical injuries, he’s a convert to cause. The COI staged some 43,000 public information films screenings between 1949 and 1950, so Charley would have been in the public consciousness.

Still from ‘Your Very Good Health’, released by the Central Office of Information to promote the new National Health Service (NHS).

Alongside films there were press adverts and pamphlets . Despite the BMA’s objections, many of these centred on the importance of choosing a GP, ‘your family doctor’. The language is utopian – ‘Anyone can use it – men, women and children. There are no age limits, and no fees to pay’.

But compromises were made – doctors were allowed to see private patients simultaneously, local authorities were given greater autonomy. They produced their own publicity, often similarly celebratory. East Ham in London celebrated the NHS as an ‘epochal event in the conquest of disease and social evil’, before providing photographs, held at The National Archives , of the various therapeutic and care services they would offer.

THE NATIONAL HEALTH SERVICE

The National Health Service will provide you with all medical, dental, and nursing care. Everyone – including all visitors to this country whether of British Nationality or not – can use it or any complete part of it. There are no charges, except for a few special items. No insurance qualifications are necessary.

An example of the pamphlets produced to explain and promote the NHS, August 1948. Catalogue reference: BN 10/32

Launch and demand

The British public quickly made use of the new health service. 95% of the population had registered for the NHS before it launched on ‘the appointed day’, 5 July 1948. Many could now access doctor care and a range of treatments previously beyond their means. Patients on doctors’ registers rose to 30 million. In the first year, over 5 million glasses prescriptions costing 32 million pounds were made. By 1951, 19 million doctor prescriptions were issued per month, up from 7 million in 1947. Four months later in December 1948, Bevan told Cabinet :

After so long a period of carping and bickering, and in spite of a largely hostile Press, the extent and speed with which [the NHS] has 'caught on' with the public is … remarkable. Aneurin ‘Nye’ Bevan

But, even then, the NHS struggled with demand. 18,000 doctors had become GPs, but it wasn’t enough yet. More nurses were needed too, with COI and Ministry of Health campaigns increasing their numbers 27% over the next five years.

A newspaper cartoon, collected by the Ministry of Health, 1948–1949. One woman says to another, ‘I had such a lovely dream last night. I was having my hair permed FREE under the National Health’. People were amazed by the medical treatments previously out of reach that were now accessible. The government worried about the cost. Catalogue reference MH 55/907

'The cost of this social innovation'

The cost was a worry, too, particularly dentistry and eyecare. Bevan allowed for some ‘abuses’ both by staff and the public, but said the main cause of expense was ‘people getting things they need but could not afford before … That, then, is the cost of social innovation.’

Partial transcript

July 5th. 1948, was a notable occasion in our history. On that day the National Health Service started, the foundation of a comprehensive service for the entire community.

The medical profession pledged itself at the start to do everything it could to make the service a success. But, and there is a very big “but”… This service cannot be a success unless the three parties concerned help to make it so:-

- Doctors, nurses and the other workers in the service

- The Government ad the administrators

- The Public

All have a part to play. Each should try to appreciate the others’ difficulties.

Remember….. no fairy wand was waved on July 5th to create new hospitals, new doctors and new nurses overnight.

Did you notice that to many of the benefits promised in the Government leaflet describing the service a warning phrase was added – “as national resources allow”? This was added with good reason. It is vital that everyone should understand the facts and not expect miracles.

In response, the ‘explanatory work’ took on another tone. A September 1948 leaflet cautioned an enthusiastic public that, ‘no fairy wand was waved on July 5th’ and advised how to take care of oneself. Bevan was eventually moved from the Ministry of Health, and later resigned as Minister of Labour over cost-saving proposals to introduce charges for dentistry, eyecare, and prescriptions. From its beginning, the NHS had to balance utopian universalism and fiscal concerns.

Records featured in this article

• From our collection PREM 4/89/2 Title The Beveridge Report Date November 1942 – April 1943
• From our collection CAB 66/46/24 Title Proposals for a National Health Service Date 5 February 1944
• From our collection PREM 8/844 Title Difficulties between the Minister of Health and British Medical Association Date 1948
• From our collection INF 2/66 Title Ministry of Labour & National Insurance: Various Campaigns Date 1945 – 1965

Discover how we are commemorating the 75th anniversary of the establishment of the NHS with some new projects and fresh insights into our collections.

Blog: The Beveridge Report and the foundations of the Welfare State

Read more about the influential 1942 report and its clarion call: 'A revolutionary moment in the world’s history is a time for revolutions, not for patching.’

Listen: The birth of the NHS

In 2018, Radio 4's UK Confidential programme headed to The National Archives to delve into and find a new perspective on the NHS files we hold.

Research guide: Doctors and nurses

This guide will help you find the doctors’ and nurses’ records that we hold and some of the most significant collections held in other archives.

Teaching resource: Atlee's Britain

This themed document collection makes available documents which reflect the birth of modern Britain with guidance for teachers on how to use these records in the classroom.

HCA Librarian

Blogging on library news, resources, services and skills for staff & students in the school of history, classics and archaeology.

NHS at 70: Explore the history of the NHS through our primary sources

70 years ago today, 5 July, the National Health Service (NHS) was established, one of a number of social and welfare reforms from the post-World War II Labour government (though initial proposals for the NHS came from the World War II coalition government). Launched just over two years after Aneurin Bevan, Minister of Health, published his National Health Service Bill, the NHS provided medical and healthcare services for free at the point of delivery.

On the NHS’s 70th birthday I have pulled together a small selection of primary resources, digital and physical, you have access to at the Library that will help you explore the history of the NHS.

What did the people think?

Mass Observation was a pioneering social research organisation founded in 1937. The aim was to create an ‘anthropology of ourselves’, and by recruiting a team of observers and a panel of volunteer writers they studied the everyday lives of ordinary people in Britain. This original work continued until the early 1950s and gives unparalleled insight into everyday life in Britain during that time.

Through our Library you have access to Mass Observation Online , which makes available the entire Mass Observation archive from that period and includes original manuscript and typescript papers (such as diaries, day reports, questionnaires, observations, etc.) created and collected by the Mass Observation organisation, as well as printed publications, photographs and some interactive features.

Mass-Observation. 1949. Meet Yourself at the Doctor’s. London: Naldrett. Available from Mass Observation Online.

In Mass Observation Online you will find a large amount of material detailing people’s opinions and experiences of the NHS from its earliest days. From Mass Observation’s own file reports and publications pulling together people’s comments, observations and experiences of the NHS to the original diary entries and questionnaire responses.

The material available allows you to read about people’s views on the NHS prior to it being launched and their opinions and experiences of the service in its first few years of existence.

When you are using Mass Observation Online the easiest way to find material regarding the NHS is by clicking on the “Popular Searches” button near the top right-hand side of page and then under the “Organisations” tab click on “National Health Service”.

This online archive is a fantastic resource for anyone interested in the everyday life of British people during this period of immense change.

You can access Mass Observation Online and other primary source databases the Library has access to via Primary Sources databases list .

What did the papers say?

Newspapers have always had a lot to say about the NHS and you can track coverage of the NHS from pre-1948 right up to the current day through the large number of online newspaper archives the Library subscribes to. Read full text articles, compare how different newspapers were covering the same issues and stories and see what events were being reported on at the time and how they were being reported.

Daily Mail Reporter. “30,000,000 Patients Already.” Daily Mail, 8 Oct, 1948, p. 3. Available from Daily Mail Historical Archive, 1896-2004.

You can search individual titles, such as The Times , The Guardian and The Observer , Daily Mail , The Scotsman , etc., or cross-search a large range of titles, such as British Library Newspapers (that covers both local and national papers) or UK Press Online (which covers popular or tabloid press).

All online newspaper archives available via the Library can be accessed from the Newspapers & Magazines database list . From this list you can also access magazine (periodical) archives which, like newspapers, can be a rich resource for historical research.

Want to look at more recent coverage of the NHS? The Library also subscribes to databases, such as Factiva and Nexis UK , that allow you to search and access the full text of a large number of UK and international newspapers from around the 1980s up to date. You can access these, the databases mentioned above and many other newspaper archives and magazine archives from Newspaper & Magazines Databases .

What to watch – then and now?

BFI InView allows you to find and view over 2,000 non-fiction film and television titles from the 20th century to the early 21st. Selected from the British Film Institute (BFI) National Archive the database allows you to explore and download rarely seen government films, written documents, newsreels, TV documentaries, discussion programmes, parliamentary recordings and much more in an indispensable resource for any study into the recent history of Britain.

Screenshot from ‘Your Very Good Health’, 1948. Available from BFI InView.

Through BFI InView you can watch public information films, documentaries, interviews, etc., related to the NHS from 1948 until 2002. This includes early government films promoting the NHS and explaining how people should use the service, like Your Very Good Health a cartoon featuring the character Charley explaining how the new National Health Service operates and the benefits a free at the point of delivery health service will offer to everyone in England or Hospitals For All a film reviewing Scotland’s various hospitals, part of the new National Health Service.

The BBC has been showing a number of programmes as part of a season on the NHS’s 70th anniversary. You can catch-up on these via Box of Broadcasts (BoB) . Why not look out for The People’s History of the NHS a crowd-sourced social history of the NHS, told through people’s treasured mementoes, whether they be the unsung medical heroes of the staff or the experiences of the patients? Or UK Confidential: The Birth of the NHS from Radio 4 where Martha Kearney examines the battles and compromises that went on behind the scenes, in the lead up to the NHS creation. Or if you’re looking for something a bit shorter Radio 4’s series National Health Stories where medical historian Professor Sally Sheard presents a series tracing decisive moments in the life of the NHS, starting with episode 1, ‘Poor Treatment’ , looking at how the British public coped before the NHS, with basic treatments and kitchen table surgery.

You can access BFI InView, BoB and other moving image databases from Image and moving image databases .

What’s in the Library’s own archives?

The University of Edinburgh holds world class collections , including rare books, archives and manuscripts, art, historical musical instruments and museum objects. The Centre for Research Collections (CRC) on the 6th floor of the Main Library is your gateway into these unique collections.

The Lothian Health Services Archives (LHSA) are part of the University’s collections. LHSA holds the historically important local records of NHS hospitals and other health-related material. They collect, preserve and catalogue these records and promote them to increase understanding of the history of health and for the benefit of all. LHSA have fantastic material related to the NHS and pre-NHS and are a must for anyone interested in history of medicine, public health, etc.

Dawn of a New Era is the LHSA’s free exhibition on the 6th floor, Main Library, celebrating 70 years of the NHS in the Lothians. From Scotland’s pre-1948 experiments in state health care, to medical breakthroughs, public health challenges and patient power, this display highlights the past 70 years of our region’s medical history through the collections of LHSA. The exhibition runs until mid-August 2018.

© Caroline Stirling

More useful online archives

The Library has access to a large range of primary source databases that allow you to search for and view primary source archive material online. Here are just a few you may want to use to find more about the history of the NHS.

National Service for Health. The Labour Party, n.d. From World Communism: Pamphlets from McMaster University (Archives Unbound).

Archives Unbound presents topically-focused digital collections of historical documents. There are currently 265 collections in Archives Unbound covering a broad range of topics from the Middle Ages forward-from Witchcraft to World War II to 20th century political history. As Archives Unbound covers such a vast range of subjects and collections, searching through the whole database is very worthwhile as you may come across useful material in collections you did not expect but you can also browse and search the individual collections.

The House of Commons Parliamentary Papers (sometimes referred to as UK Parliamentary Papers ) contains bibliographic records and searchable full text for papers printed between 1688-2014 and it also includes Hansard 1803-2005. It’s a really rich and detailed primary source for Britain, its colonies and the wider world and are an important part of the world’s historical record.

The Churchill Archive includes more than 800,000 pages of original documents, produced between 1874 and 1965, ranging from Winston S. Churchill’s personal correspondence to his official exchanges with kings, presidents, politicians, and military leaders.

Screenshot of 1st page of partial speech notes for Winston Churchill’s speech on advances in medicine and science to the Royal College of Physicians, London. 2 March, 1944. Part of larger file CHAR 9/204A-C. Churchill Archive.

You can access these and other primary source databases the Library has access to via the Primary Sources databases list .

Access to library databases are only available to current students and members of staff at the University of Edinburgh.

Caroline Stirling – Academic Support Librarian for History, Classics and Archaeology

Blog History of government

https://history.blog.gov.uk/2023/07/13/the-founding-of-the-nhs-75-years-on/

The founding of the NHS: 75 years on

On 5 th July 1948 the National Health Service was established in the United Kingdom. Britain was the first western country to offer free at the point of use medical care to the whole population. [1] Seventy-five years on the NHS continues to be a distinguishing feature of the British welfare state.

But how did the NHS come to be? Let us look back to the creation of the National Health Service and how the government of the day led by Prime Minister Clement Attlee set about introducing this transformative reform.

The Second World War led to an immense loss of life and induced considerable hardships. Britons endured rationing (which continued after the war was over), evacuation, destruction or damage to millions of homes and workplaces, air raids as well as the mass pivoting of the nation’s people and resources to meet the vast war effort. The period between the First and Second World Wars had also left its mark. The interwar years were a time of economic depression and social deprivation, there had been no great development of state provision. Attlee and his Cabinet had lived through (and in many cases fought in) both wars and recognised the need for reconstruction and expansion – a comprehensive welfare system was at the heart of this.

During the Second World War, the coalition government led by Conservative Prime Minister Winston Churchill and Leader of the Labour Party Clement Attlee (Deputy Prime Minister from 1942) seized on the need for post war reconstruction. Despite the preoccupation with fighting a world war, the government prioritised planning for this. In June 1941, Labour minister Arthur Greenwood announced to the House of Commons that a new committee had been formed to survey existing social security provision and allied services under the chairmanship of Sir William Beveridge. [2] This became the totemic 1942 Beveridge Report, which identified ‘Five Giants’ that needed to be tackled in order for Britain to succeed economically and socially. The five giants were Want, Disease, Ignorance, Squalor and Idleness. Influential economist and civil servant John Maynard Keynes was also consulted by Beveridge during the making of the report. At his suggestion Beveridge modified some recommendations, thus Keynes believed the plan to be broadly affordable. [3]

The report was published on 2 nd December 1942 and immediately became a best-seller at home and abroad (costing 2 shillings). [4] Some 256,000 copies of the full report, 369,000 copies of an abridged version and 40,000 copies of an American edition were sold in twelve months. [5] The proposals received widespread support across the political spectrum. The recommendations of the Beveridge Report widened the scope set by Lloyd George’s National Insurance Act (1911). Beveridge offered a blueprint for a comprehensive welfare state. In the years after publication, the coalition government worked on plans for turning the recommendations into reality, including producing a White Paper. Full implementation was however not guaranteed. In March 1943, Churchill warned against imposing significant new expenditures without knowing the full post war economic picture; yet he also advocated a ‘national compulsory insurance for all classes for all purposes from the cradle to the grave.’ [6]

On 5 th July 1945 the Labour Party led by Clement Attlee won a landslide victory at the polls, with a majority of 146 seats. [7] After winning the General Election, the Attlee government set about creating a comprehensive welfare state, at the heart of which was the NHS. Indeed Labour had entered the election offering ‘the full Beveridge’. [8] Attlee’s ‘executive efficiency’ would be integral to introducing and implementing such a huge programme. [9] Though Britain and its allies had emerged victorious, the strain of total war had left the country in a desperate state. Yet Attlee reflected:

We had not been elected to try to patch up an old system but to make something new ... I therefore determined that we would go ahead as fast as possible with our programme. [10]

Attlee’s social and political work in the East End of London shaped his view of the role of the state. By the time he was in government, ideas that had seemed very much his own were now part of an emerging consensus. Attlee wrote, ‘I have witnessed now the acceptance by all leading politicians in this country and all the economists of any account of the conception of the utilisation of abundance.’ [11] In 1918 as a soldier in the First World War Attlee expounded his sense of purpose, ‘We live in a state of society where the vast majority live stunted lives – we endeavour to give them a freer life.’ [12]

On arrival in Downing Street, Attlee faced a challenging economic picture. A month into office it got gloomier with the abrupt end of the US Lend-Lease scheme. Subsequently the US made a further loan agreement with Britain however Hugh Dalton, Attlee’s Chancellor of the Exchequer (1945-47) noted that the situation remained ‘desperately difficult’. [13] US Marshall Aid from 1948 until 1951 would also provide critical support for the British economy. Attlee, in assembling his Cabinet, appointed the political firebrand, South Wales miner and trade unionist Aneurin Bevan as Minister of Health. The King’s Speech on 15 th August 1945 outlined an ambitious legislative programme including nationalisation of the fuel and power industries, civil aviation, Bank of England as well as establishing a National Health Service. [14] Chancellor Hugh Dalton worked closely with Bevan to establish the financial foundation for the introduction of the NHS. Dalton found Bevan’s vitality and drive impressive, and Bevan’s biographer credits Dalton as ‘after Bevan … the chief architect’ of the NHS. [15]

During the Second World War, the scope of health insurance had been extended but it covered just half of the population and did not include hospital and specialist services, dental, optical, or hearing services. [16] Universal provision regardless of ability to pay was at the core of the Attlee government’s new reforms. Minster of Health, Bevan set about building on the Beveridge Report and the coalition government’s White Paper. In October 1945, Bevan outlined his vision for a National Health Service. In December, he explained to Cabinet that this was ‘an opportunity, which may not recur for years, for a thorough overhaul and reconstruction of the country’s health position.’ [17] Prime Minister Attlee drew on a cricket metaphor to express his approval, Bevan had done well “on a pretty sticky wicket”. [18] Provisions would include hospital care, ambulance services, GP services, maternity care, prescriptions as well as optical care and dentistry. [19]

Turning the NHS from principle to policy required significant structural change and thus extensive negotiations with the medical profession, local authorities, committees, Parliament and with other Cabinet ministers. It was an arduous process to say the least. What’s more, the NHS was one of a series of reforms which formed the welfare state. How the state would pay for these reforms was a huge matter for the government of the day. Keynes had told the War Cabinet in May 1945 that Britain faced a ‘financial Dunkirk’. [20] The 1946 National Insurance Act [21] extended the contributions of working age people (except married women) in order to contribute to funding the provisions of the welfare state.

Given its foundational status for the whole welfare programme, Attlee focused his attention on ensuring the passage of the National Insurance Bill. In the House of Commons during the first and second readings, Attlee reflected on the historical battle for social reform and credited earlier pioneers. [22] The Prime Minister also acknowledged the significant financial cost:

The question is asked – can we afford it? … Supposing the answer is “No”, what does that mean? It really means that the sum total of the goods produced and the services rendered by the people of this country is not sufficient to provide for all our people at all times, in sickness, in health, in youth and in age ... I cannot believe … that we can submit to the world that the masses of our people must be condemned to penury. [23]

The National Health Service Act received Royal Assent on 6 th November 1946. This however marked the beginning of a deeper, more protracted phase of negotiations in the run up to so-called “Appointed Day” on 5 th July 1948 – when NHS provision would begin. As such 1,143 voluntary hospitals (90,000 beds) and 1,545 municipal hospitals (390,000 beds) were taken over by the NHS in England and Wales. [24]

Historian Pauline Gregg recounted how nail-bitingly close it got:

Six months before the Appointed Day it looked as though the whole edifice might crash through lack of support from the medical profession; but a near-last-minute agreement saved the structure. [25]

Up to this point the medical profession exercised a significant degree of autonomy and so the creation of a National Health Service would lead to some loss of freedom as well as increased bureaucratic demands. Bevan recognised this and stated:

Any health service which hopes to win the consent of the doctors must allay these fears. … There is no alternative to self-government by the medical profession in all matters affecting the content of its academic life. … It is for the community to provide the apparatus of medicine for the doctor. It is for him to use it freely in accordance with the standards of his profession. [26]

The Minister of Health however was also determined to deliver his mission:

No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means. [27]

Bevan secured the support of Cabinet to table a debate in the Commons on 9 th February 1948, which confirmed the government’s determination to begin NHS provision on Appointed Day. [28] In the February debate, Bevan detailed the ‘wholesale resistance to the implementation’ the NHS Act from the professional bodies. [29] Over the proceeding months, Bevan made concessions and gave assurances to the medical profession on clinical freedom. [30] By Appointed Day, a majority of GPs had applied to enter the NHS and three quarters of the population had registered with the NHS. [31] As the river of NHS provision began to flow, Bevan turned to his Parliamentary Private Secretary Barbara Castle and said:

Barbara, if you want to know what all this is for, look in the perambulators [prams]. [32]

Dr Michelle Clement  is Lecturer and researcher on government reform and delivery at The Strand Group, King’s College London and Researcher in Residence at No.10 Downing Street. @MLClem @TheStrandGroup

[1] R. Klein, The New Politics of the NHS (Radcliffe Publishing, 2006), p.1.

[2] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), p.18.

[3] J. Harris, William Beveridge: A Biography (OUP, 1977), p.412.

[4] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), p.19.

[5] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), p.19.

[6] M. Gilbert, Winston S. Churchill: Road to Victory 1941-45 (Heinemann, 1986), p.367.

[7] The first overall majority for the Labour Party.

[8] P. Hennessy, A Duty of Care: Britain Before and After Covid (Penguin, 2022), p.5.

[9] R. Burridge, Clement Attlee (Cape, 1985), p.204

[10] C. Attlee, As It Happened (Sharpe Books, 2019), p.165.

[11] J. Bew, Citizen Clem (Kindle edition, riverrun, 2016), p.578.

[12] J. Bew, Citizen Clem (Kindle edition, riverrun, 2016), p.579.

[13] H. Dalton, High Tide and After: Memoirs 1945-1960 (Muller, 1962), p.xi.

[14] The King’s Speech, Hansard, Vol. 137, 15 August 1945.

[15] B. Pimlott, Hugh Dalton (Papermac, 1986), p.495.

[16] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), p.49.

[17] CAB/129/5 ‘Proposals for a National Health Service’, 13 December 1945, The National Archives,

http://filestore.nationalarchives.gov.uk/pdfs/small/cab-129-5-cp-45-339-39.pdf

[18] J. Bew, Citizen Clem (Kindle edition, riverrun, 2016), p.567.

[19] In 1951, under the Attlee government, charges for dentistry and optical care were introduced. The following year the Churchill government brought in prescription charges.

[20] P. Hennessy, A Duty of Care: Britain Before and After Covid (Penguin, 2022), p.7.

[21] Which built on the 1911 National Insurance Act.

[22] J. Bew, Citizen Clem (Kindle edition, riverrun, 2016), p.573.

[23] P. Hennessy, Never Again: Britain 1945-51 (Cape, 1992), p.119.

[24] G. Rivett, “1948-1957: Establishing the National Health Service”, Nuffield Trust , 2014,

https://www.nuffieldtrust.org.uk/chapter/1948-1957-establishing-the-national-health-service

[25] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), p.51.

[26] A. Bevan, In Place of Fear (Kindle edition, Lume Books, 2020), Loc 1605-1630.

[27] A. Bevan, In Place of Fear (Kindle edition, Lume Books, 2020), Loc 1353.

[28] K. Harris, Attlee (Weidenfeld and Nicolson, 1982), p.423.

[29] House of Commons ‘National Health Service’ Debate, 9 February 1948,

https://api.parliament.uk/historic-hansard/commons/1948/feb/09/national-health-service

[30] R. Lowe, The Welfare State in Britain since 1945 (Palgrave Macmillan, 2005), p.179

[31] P. Gregg, The Welfare State (George G. Harrap & Co, 1967), pp.62-63.

[32] P. Hennessy, Distilling the Frenzy: Writing the History of One’s Own Times (Biteback, 2012), p.10.

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The Birth of the NHS

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.

Jessica Brain

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.

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.

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.

Published: 30th June 2021.

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The NHS: Britain’s National Health Service, 1948-2020

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The NHS: Britain’s National Health Service, 1948-2020 , Susan Cohen, Shire Publications, 2020,64p, £8-99. ISBN 978-1-78442-482-4

For most of us in the United Kingdom, the National Health Service has been a constant feature for all of our lives. Susan Cohen offers us a brief summary of the development and achievements of this institution which has served the nation faithfully for over seventy years.

She has given us a sense of how it emerged from earlier medical advances and late nineteenth century social reform, pinpointing Aneurin Bevan’s belief that the pathway to an NHS can be seen in the limited provisions of the National Insurance Act of 1911. The war-time preparations for a form of NHS under the Coalition Government are clearly explained, thereby revealing that the ambition for some form of NHS had all-party political support; and she explains how the various medical professionals were drawn into this ambitious national provision.

Her analysis of all the challenges faced by the NHS is very helpful. This ranges from the initial pressures which led to the imposition of charges for dental and optical services, when pent-up demand threatened to undermine the finances of this emerging provision, through the medical developments which the NHS has embraced, such as transplant surgery and IVF; and the responses to HIV/AIDS in the 1980s and the challenge it now faces to cope with the current COVID 19 crisis.

This is very succinct and informative and does easily enable the reader to set their own experience of health provision in the context of the emergence of this substantial and highly valued public service.

Part of Humanities - History (Wales) Change and movement

The National Health Service is a free medical and healthcare funded by the taxes close taxes Compulsory financial contribution to the government that is spent on maintaining services. that people pay.

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The NHS – what is it exactly? We’ve gone from this … to this.

This is the history of the National Health Service and our thanks goes to two Welshmen. One, was Aneurin 'Nye' Bevan, and the other was his colleague, Jim Griffiths.

When Aneurin Bevan became health minister in 1945, at the end of World War Two he thought that the government should take responsibility for the health of the British people, and that the services provided should be free of charge. Jim Griffiths, Labour MP for Llanelli, thought that this should be a lifelong service too, agreeing with William Beveridge that it should be a service from cradle to grave. Fortunately for us, this is still the case today.

Did you know that World War Two was one of the main reasons for change in our health system? Because so many soldiers were wounded, the government stepped in to help and created the Emergency Hospital Service. The soldiers weren’t the only ones who needed medical care. The long war affected the health of the British people in general. Thanks to Aneurin Bevan, Jim Griffiths and other pioneering government members, the NHS was born on 5 July 1948.

It’s hard to believe that before the summer of 1948 it was only those with money who could afford to use the health services. Aneurin Bevan and Jim Griffiths didn’t want to discriminate against those with no money and for the first time everyone had access to the health service.

Over the years, it’s seen many changes, developments and improvements. It is a free health service for all in the UK. In many countries you still have to pay to see a doctor. Thanks to the NHS we are healthier and living for longer.

Establishing the National Health Service

The beveridge report.

In 1941, the coalition government close coalition government A government formed of more than one political party. commissioned Sir William Beveridge to look at ways of rebuilding Britain following the Second World War.

In 1942, Beveridge published his report, and it contained a series of recommendations. His report noted the need to beat ‘five giants’ to rebuild the country following the war, namely:

• want – adequate income for all
• disease – access to healthcare
• ignorance – a good education
• squalor – adequate housing
• idleness – gainful employment

One of its recommendations to address these was the establishment of a welfare state .

Aneurin Bevan

The Labour party won the election in 1945, and Welshman Aneurin Bevan was appointed Minister of Health – and he was responsible for establishing the National Health Service .

Aneurin Bevan was inspired by an existing health system in Tredegar, the town where he was born.

In 1969, the powers over the NHS in Wales were conferred on the Secretary of State for Wales. Since Welsh devolution close devolution The transfer of some powers from a central government to a more local level, eg from the UK Government to the Welsh Government. in 1997, the powers are now under the control of the Welsh Government and the Minister for Health and Social Services.

Over the years, the cost of providing care has increased, putting pressure on the service, and not all elements of the NHS are now free, eg eye tests. The population is also ageing as a result of the care and therefore places more stress on the service.

Since the Covid-19 pandemic, which started in March 2020, the NHS has faced huge pressures. Sections such as mental health services and GPs have been under strain since the pandemic due to staff shortages, increased demand and long waiting lists, for example.

However, healthcare is still free to all members of society and there is an increase in the life expectancy of people in the UK.

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Setting the scene

The National Health Service (NHS) began on 5 July 1948. Already the NHS, which Bevan described as “a great and novel undertaking”, is the stuff of history. Few people now working in it had been born when it began. Those with clear memories of the early days grow fewer, and this book is in part a tribute to their work. It is the story of the NHS, how it was set up, what happened next, and why. It aims to give the reader, whether professionally involved in the NHS or not, a chronological framework of the main events, clinical and organisational. The clinical sections describe the vast and wide-ranging developments that have imposed demands on the organisation, finance and structure of the NHS. Much of the story of the NHS is about the interaction of the three main parties involved: those needing care, those who deliver skilled care, and those whose task it is to raise the money and see it properly spent. The peculiarly difficult triangular relationship between these interested parties has to be satisfactory if the health service is to function to the benefit of society. 1  Knowledge of the evolution of the service, and the changes brought about by the advance of medical science, should help those planning, managing or working in the NHS to be realistic. Advance in clinical medicine is international and it has often been developments in other countries that have led to new forms of treatment, and sometimes new patterns of organisation. Only rarely do advances stem from the work of a single pioneer; usually they are the work of a team, or several teams. Charles Rosenberg says in his history of hospitals in the USA: 2

The decisions that shaped the modern hospital have been consistently guided by the world of medical ideas and values . . . the attitudes and aspirations that gave the profession its peculiar identity . . . One can hardly understand the evolution of the hospital without some understanding of the power of ideas, of the allure of innovation, of the promised amelioration of painful and incapacitating symptoms through an increasingly effective hospital-based technology. Management has a tough task to keep up with clinical progress. The implementation of developments has often been slower in the UK than in other countries. Partly this has been due to innate conservatism, but mainly it has been the result of financial restrictions.

There is no ideal way of dividing this story into sections. The introductory chapter describes the health services in 1948. The next chapters each cover a decade, and begin with a chronology of events both in the NHS and in national life. The structure of the chapters is broadly consistent so that a particular topic can be followed over the years. In each decade medical progress is considered first, then the developments in general practice and primary healthcare (the patient’s first point of contact with the system) and the hospital service. Lastly, changes at an organisational and managerial level are discussed.

The story of clinical and organisational developments in the NHS can be seen within the wider context of the development of the welfare state, about which Nicholas Timmins has written. 3  To keep within reasonable limits, boundaries had to be drawn. This book concentrates on England, for organisational changes in Scotland, Wales and Northern Ireland differed, reflecting the different circumstances. It does not duplicate accounts of the creation of the NHS. 4 5  It tries to avoid looking at the NHS through the eyes of central government and does not explore the political background as deeply as Rudolf Klein. 6  Neither does it deal with the types of care that shade into social services. The temptation to stray into clinical research leading to advances in medicine, or to explore in any depth the relation between income, illness and mortality, had to be resisted. It was not practicable to include the stories of optical, dental and pharmaceutical services; each could be the subject of a book itself. 

The use of English has changed substantially over the last 50 years. It was assumed in 1948 that doctors were men, and could be referred to as masculine. Concepts were expressed with little regard for the possible offence they might cause; terms such as ‘mental defectives’ and ‘the workhouse’ were well understood and few objections were made to their use. They have changed over time: a White Paper in the 1970s referred to the mentally handicapped but we now talk of people with learning difficulties; senile dements became elderly severely mentally infirm (ESMI), a phrase also now consigned to limbo. I have tried to use contemporary terminology and not change the words people used; increased sensitivity to those with problems is, in itself, part of the history of the NHS.

References to preface

Online resources have expanded substantially since the book was written. For example, the National Archives have a  hospital database,  and the London School of Hygiene & Tropical Medicine has one of  voluntary hospitals . Poor Law hospitals and workhouses  are covered by another site, and hospitals in London that have closed and disappeared by  Lost Hospitals .

The Socialist Health Association, in conjunction with Hull University, has a  substantial archive of documents , some of national importance, and others part of the history of the Labour Party in respect of healthcare.

Clark-Kennedy AE. Medicine in relation to society. BMJ 1955; 1: 619–23.

Rosenberg C. The care of strangers – the rise of America’s hospital system. New York: Basic Books, 1987, 7.

Timmins N. The five giants: a biography of the welfare state. London: HarperCollins, 1995.

Pater JE. The making of the National Health Service. London: King’s Fund, 1981.

Webster C. The health services since the war. vol 1. To 1957. London: HMSO, 1988.

Klein R. The new politics of the NHS, 3rd edn. London and New York: Longman, 1995. (First published 1983).

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The NHS: the story so far (1948-2010)

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• Pressure Medicine & Life Sciences 100%
• Public Sector Medicine & Life Sciences 90%
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T1 - The NHS: the story so far (1948-2010)

AU - Shapiro, Jonathan

PY - 2010/8/1

Y1 - 2010/8/1

N2 - The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. Equally important is the changing nature of both medical technology and public expectation, each of which exert constant and inexorable pressures on the service. This article will briefly describe the story of the NHS from its inception in 1948 to the present day, with an emphasis on developments over the last 20 years. During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal sign-posting some of the topics that will be followed up in these articles.

AB - The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. Equally important is the changing nature of both medical technology and public expectation, each of which exert constant and inexorable pressures on the service. This article will briefly describe the story of the NHS from its inception in 1948 to the present day, with an emphasis on developments over the last 20 years. During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal sign-posting some of the topics that will be followed up in these articles.

KW - history

KW - healthcare

M3 - Article

C2 - 20849005

SN - 1473-4893

JO - Clinical Medicine

JF - Clinical Medicine

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• Health and social care
• National Health Service

NHS Constitution plans to strengthen privacy, dignity and safety

Proposed updates to NHS Constitution for England will reflect biological needs of patients and empower people to request same-sex wards and care.

• Proposed updated NHS Constitution for England would introduce new rapid reviews for patients and better recognise the important role of NHS volunteers
• Putting patients and their families, carers and advocates at the heart of decision making, and strengthening links between NHS services

The privacy, dignity and safety of all patients are to be embedded in how the NHS operates under a new constitution that aims to shape the principles and values of the NHS.  

In the proposed changes to the NHS Constitution for England , patients will be empowered to request that intimate care is carried out by someone of the same biological sex, where reasonably possible.   

An updated NHS Constitution would reinforce the NHS’s commitment to providing single-sex wards. This includes setting out that placing transgender patients in single-room accommodation is permissible under the Equality Act 2010 when it is appropriate, such as respecting a patient’s wish to be in a single-sex ward. 

The government has been clear that biological sex matters. The constitution proposal makes clear what patients can expect from NHS services in meeting their needs, including the different biological needs of the sexes. Illnesses and conditions that we know impact men and women differently should be communicated in a clear and accurate way.   

The consultation also plans to embed the right for patients’ and their loved ones’ access to a rapid review from outside the care team if the patient is deteriorating. The importance of this pledge has been made clear by the tragic story of Martha Mills.

It will run for 8 weeks. The government will consider responses from everyone including patients, the public, staff and NHS organisations, before publishing a response and a new NHS Constitution. 

Health and Social Care Secretary, Victoria Atkins, said:  

We want to make it abundantly clear that if a patient wants same-sex care they should have access to it wherever reasonably possible.   We have always been clear that sex matters and our services should respect that. By putting this in the NHS Constitution we’re highlighting the importance of balancing the rights and needs of all patients to make a healthcare system that is faster, simpler and fairer for all.

Additional updates the government is proposing include:   

• embedding the commitment for patients and their family members in acute and specialist settings to initiate a rapid review of care from outside their initial care team, where the patient’s condition is deteriorating. Not only does this provide a boost to patient safety, but it also puts patients at the heart of their own care
• ensuring the health system works together to understand the needs of different groups within each community and reduce disparities in access, experience and outcomes for all
• strengthening responsibilities on patients to cancel or reschedule appointments and on the NHS to communicate appointment information clearly
• making clear that patients can expect their physical and mental health care to be person-centred, co-ordinated and tailored to their needs
• reinforcing the NHS’s commitment to unpaid carers

Minister for Women’s Health Strategy, Maria Caulfield, said:  

Updating the NHS Constitution is crucial to ensuring the principles underpinning our NHS work for everyone.   This is about putting patients first, giving them the dignity and respect that they deserve when they are at their most vulnerable. Our plans include accommodating requests for same-sex intimate care and respecting single-sex wards.  We’ll also recognise the important role of patients’ loved ones in raising concerns about their care.

The constitution aims to safeguard the principles and values of the NHS. It empowers staff to help improve the care it provides by setting out legal rights for patients and staff when using NHS services. It also sets out clear expectations about the behaviour of both staff and patients, and the role they need to play in supporting the NHS.   

The proposed updates to the constitution will also support the government’s mission to help people to remain in, and return to work, which reflects the important impact that work can have on a person’s health and wellbeing.

Louise Ansari, Chief Executive of Healthwatch England, said: 

The NHS Constitution plays a crucial role in shaping the culture of our NHS and helping the public to know their rights.  Since the NHS Constitution launched, it has helped to shift the balance of power from services towards patients and their families. But, with only a third of people knowing their rights, there is still a long way to go.  Given the challenges our NHS faces, a conversation to reaffirm and raise awareness of the most important rights to the public has never been more timely.  We urge everyone to take part in the consultation and have their say. This is your opportunity to send a clear message about the rights you hold most dear. 

Background information

The NHS Constitution for England was last updated in 2015. It has to be updated at least every 10 years by the Secretary of State. It is a document outlining the rights of patients and staff.

The consultation will be the first stage of a review of the constitution and will run for 8 weeks.

The government will consider responses from everyone, including the public, clinicians and medical professionals, patients, carers and organisations representing patients and staff and health stakeholders, before publishing the consultation response.

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