The National Health Service

The National Health Service was one of the major achievements of Atlee’s Labour government. The National Health Service (NHS) was introduced in 1948. This service provided free medical treatment for everyone. The driving force behind the NHS was Aneurin Bevan, Minister of Health.

The majority of doctors were opposed to the introduction of the NHS as they believed that they would lose money as a result of it. Their main opposition to the NHS was their belief that their professional freedom would be jeopardised i.e. that they would treat fewer private patients and, as a result, lose out financially. They also believed that the NHS would not allow patients to pick their doctor – though this proved to be an unfounded worry.

Once the NHS was introduced, it did prove to be popular with most people. 95% of all of the medical profession joined the NHS. In fact, the NHS proved to be too popular as it quickly found that its resources were being used up. From its earliest days, the NHS seemed to be short of money. Annual sums put aside for treatment such as dental surgery and glasses were quickly used up. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million.

However, the popularity of the NHS meant that in the 1950 election, the Conservatives promised to keep it – though this was of little importance as Labour won that election.

In 1951, the Labour government introduced a charge for some dental treatment (free false teeth) and for prescriptions for medicine. Aneurin Bevan resigned from the government in protest at this. Bevan wanted a free health service and nothing else.

1948-1957

The National Health Service became reality on 5 July 1948. Plans for a health service had been made during the years of the Second World War, 1939-1945. Both the major political parties had schemes, but the one adopted was that of a new Labour administration and Aneurin Bevan

The principals of the NHS

The NHS was based on principles unlike anything that had gone before in the UK, and few other countries followed these.

← The service was financed almost 100% from central taxation. The rich therefore paid more than the poor for comparable benefits ← Everyone was eligible for care, even people temporarily resident or visiting the country. Anybody could be referred to any hospital, local or more distant. ← Care was entirely free at the point of use, although prescription changes and dental charges were subsequently introduced ← Organisation was based upon 14 Regional Hospital Boards that funded and oversaw more local hospital management committees. The teaching hospitals were directly responsible to the Ministry of Health

It was a momentous achievement and everybody wanted the new service to work. However, food was still rationed, building materials were short. The war had created a housing crisis - alongside post-war re-building of cities, and the designation of overspill areas, the New Towns Act (1946) created major new centres of population and all needed health services. The distribution of services was poor, with major hospitals in large cities but poor services in rural areas. The NHS was founded just at the time when massive innovation was occurring in the availability of drugs. Antibiotics, better anaesthetic agents, cortisone, drugs for the treatment of mental illness such as depression, good diuretics for heart failure, and the antihistamines all became available. These advances, as well as better radiology systems, raised the cost of the NHS while improving the lot of the patient.

Financial problems were substantial. It had been hard to cost in advance the day-to-day costs of the new service and public expectations rose. Medical science was rapidly gathering pace, but while hospital beds for tuberculosis and infectious diseases were closed, allowing cash to be released for other services, new developments outpaced savings. More mothers were wanting their babies delivered in hospital, cardiac surgery was being applied to rheumatic heart disease, and the first hip replacements were being performed. Initial estimates of the cost of the NHS were soon exceeded as newer, more expensive and more frequently used drugs were developed. Within three years of its creation the NHS, which had been conceived as free of direct charges for everyone, was forced to introduce some modest fees. Prescription charges of one shilling (5p), which had been legislated for as early as 1949 but not implemented, were introduced in 1952. A flat rate of £1 for ordinary dental treatment was brought in at the same time.