The history of the NHS: 1948-1957

Considering how vital the NHS is to us in the UK, it seems almost impossible to imagine how life was back in 1948. In the last 70 years the NHS has blossomed into what it is today, and it is quite nice to step back and reminisce on the how the NHS began. By 1948 there were already many reasons stacking up in favour of a national health service. For example, many believed that health care shouldn’t solely be bestowed through charity; there were also many accumulating financial difficulties for the voluntary hospitals; during WWII the creation of an emergency service was mandatory for the war effort; due to the devastation of war, it was possible to have a drastic change of system and finally the newbies of the medical profession had new modern ideas on how to provide a good health service. So, to start the ball rolling, in 1920 Lord Dawson produced a report on how a new health service could be organised. At this time, the general health services were a mess and quality varied extensively from town to town, rich and poor. During the war in 1939, an emergency medical service was instantly created. This proved how the government were in fact capable of forming a national health service. By 1945, still within the clutches of war, the Conservative party produced the first White Paper. This paper outlined a future health service in which local authorities would lead, i.e. decisions would not be made by the government but rather by local authorities. However in 1945 Labour made it into parliament, so a radically different plan was drawn up which nationalised all hospitals (both the voluntary council ones). This was the initial plan that eventually materialised. Thus, in 1948 the NHS was born under the management of the health secretary at the time Aneurin Bevan.

At this time, people were living in austere conditions. With few luxuries, continual rationing and worn out from war, the access to free health care must have been life-changing.

The principles of the NHS

Outside the eastern block, very few other countries took the route that the UK followed. These new principles were revolutionary.

  1. 100% tax funded. In this way, the rich paid more than the poor for nearly equivalent benefits. For the Labour party, this was regarded as a crucial part of the scheme.
  2. The health care would reach everyone and meet the needs of everyone. From the rich and the poor, visitors or permanent residents, this free healthcare was eligible for everyone and purely based on clinical need rather than ability to pay.
  3. It was free. Apart from prescription charges and dental charges, the care should be free for everyone.

What was it like pre-NHS?

GPs: Workers had free access to a GP, but this excluded their families, the more well-off workers and the retired. Poorer people could sometimes obtain care through GP funded charities, although they had very little right to healthcare.

Hospitals: Compared to today, the quality of healthcare in hospitals was severely lacking. Bed-rest was the major treatment for aliments from heart attacks to tuberculosis. Some hospitals were ancient and wealthy, owning valuable assets such as property in London. The treatment from hospitals was by no means impartial: patients were charged if they could afford to be, and those who were too poor were not. The majority of hospitals were voluntary and self funded, such as St Bartholomew’s and Guy’s and St Thomas’.

Local authority services: The municipal hospitals were a service to their ratepayers. Services such as maternity hospitals, hospitals for infectious diseases were also provided by the local authorities. Yet the standard of what was provided depended on the area and the attitude of the Council.

How was the early NHS administered?

This new service was run as a ‘tripartite’. There were three main governing sections to the NHS:

  1. Hospitals. The voluntary and municipal hospitals were merged together in a single system, thus abolishing the voluntary hospitals so all staff were salaried.  There were 14 Regional Hospital Boards which oversaw the local hospital management committees. The teaching hospitals were responsible to the Ministry of Health rather than the region they were based in, since they ‘served the nation, not the locality’.
  2. Primary Care was the second pillar of the NHS:An Executive Council of GP’s was set up, under which family doctors, dentists, opticians and pharmacists were self-employed under a contract. Due to the war there was a shortage of GP’s and the funds had been severely capped. In 1955 a sum of money was given GP’s to develop group practices with more than one GP. The role of Dental surgeries included check-ups, fillings and dentures. Opticians would provide eye tests if requested by a GP. Pharmacists were responsible for prescriptions and over the counter remedies.
  3. The third sector of the NHS consisted of the Local Health Authority, managed by a Medical Officer of Health. Although losing power over the municipal hospitals (now grouped with all other hospitals), the immunisation and maternity clinics were still ran by this figure. A special priority service for expectant and nursing mothers was suggested, however few were actually built. Family doctors, dentists, nurses, chiropodists and others were organised to work together to provide immediate services when required. Specialist ear clinics were also organised so patients could acquire expert opinions and hearing aid if needed.

organisational chart

During the first few years of the NHS, the funding provided to each hospital was the same as it was prior to its set up. Managing the costs was tough. Within the first three years, due to rapid advancements in medicine new treatments were forever becoming available. This increased the running costs of the NHS, resulting in an inevitable prescription charge of one shilling (5p) in 1952 and a dental treatment fee of £1.

Here is a short timeline of changes to the NHS service and the major medical advancements.

1948 – NHS founded

1952-  Prescription charges introduced, one  shilling

1954- Sir Richard Doll and Sir Bradford hill uncover the link between smoking and cancer

1954- Daily hospital visits allowed for children 

Of course, with such a drastic change to the nation many difficulties would naturally follow its creation. How to organise and manage the service; fundings; balancing the conflicting demands of patients, staff and taxpayers; how to fairly and equitably allocate supplies to the areas most in need and many more. The list could go on inexorably.

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