The NHS: The Amazing Story of its Creation

July 5^th 1948 was one of the most important days for the establishment of Modern Britain. After the ravages of the two global conflicts the country was recovering from economic and physical ruin. But even with huge financial constraints and pressure from America to spend the money elsewhere the Labour government of Clement Atlee created the lifeline of Britain, the National Health Service. Today we celebrate the 70^th Anniversary of the greatest British establishment of all time. The history of the NHS is all about the mutual co-operation of British peoples to help one another, however the greatest credit must be given to Aneurin Bevan who worked so hard to create the amazing health service we still benefit from today.

Not a New Idea

The idea of a public health service had been under discussion in Britain for decades. Gone were the times of poorhouses punishing those less well off. Indeed from 1911, under the Liberal governments of Asquith and Lloyd George, the country had a more altruistic outlook on the treatment of those less well off in society. “Panel systems” were set up so that many working-class people could have access to free, government funded healthcare.  This made a positive difference, but only to those who were working and not their families.

The first major step to an amalgamated state health service came in anticipation of the breakout of World War II. The government enacted an Emergency Medical Service in order to run healthcare centrally to be able to prepare for the expected casualties. However this again had limited beneficiaries as this new centralised health service was used almost exclusively by service people, but did include the treatment of other like:  Civil Defence workers, Home Guard, Police War Reservists injured on duty, unaccompanied evacuated children, elderly and disabled people evacuated from shelters,  essential war-workers, seamen of the Merchant Navy, evacuated or homeless persons along with some very select special cases.

Although hospitals were amalgamated, making the eventual centralised nature of the NHS easier, a change in ideology also occurred in the pre-war years. The William Beveridge report was one of the most influential government investigations to British and global welfare standards. Beveridge explained that government assistance could remove the five “Giant Evils” in society: squalor, ignorance, want, idleness and disease. This amazing report, officially entitled “Social Insurance and Allied Services” inspired the expansion of National Insurance, the growth of government provisions in many areas such as education and the creation of the NHS.

William Beveridge, a great instigator in the change of British attitudes towards welfare.

Change Occurring in Britain

In 1945 although Winston Churchill lead Britain to victory in the Second World War he was not seen as the person to take the country forward in the post war years. Instead Clement Attlee and his Labour government had won by a landslide victory and presented a huge majority to implement the party’s manifesto. One of the core promises of this manifesto was the creation of the “Welfare State”. Attlee and his party reiterated the popular feeling of reform of the time. They had a clear cohesive plan for the future of the country that echoed the words of Beveridge and appealed to many of the people affected by the violence and the hardship of the war years. On top of this Churchill, to many British voters, was a symbol of war. Although grateful for Churchill's work they wanted a government for their peacetime future.

The Parliamentary majority of the Labour Party meant that their ideas from the manifesto could be implemented relatively easily without opposition. The hardship was arranging the funding for it with Britain footing a huge bill for the war. However the creation of the NHS was far from easy.

A newspaper cartoon showing Prime Minister Atlee trying to "slay" the Five Giants

Aneurin Bevan: A Hard Job to Achieve the Dream

The implementation of the idea of the NHS, and arranging all of it with the financial situation in mind, was down to the youngest member of the new Labour government, Aneurin Bevan. There was cross party agreement to the idea of the NHS, although Conservatives debated over whether government should centrally control NHS hospitals or if control should be handed over at more local levels. The government passed the National Health Service Act 1946 but there was much still to be arranged.

Parliamentary Archives showing the National Health Service Act 1946

Aneurin Bevan had a difficult task on his hands. Funding and financial planning was already tough enough. The Conservatives put pressure on him over the arrangements of management. However, one of his biggest struggles stemmed from the medical profession itself. Many doctors, dentists and other medical workers opposed the NHS on the grounds of autonomy and pay. These people were doing very well from privately seeing people and did not want to lose their right to earn. On top of this they did not want to have imposed working hours laid down by the government. In the end Bevan sorted a deal by “stuffing their mouths with gold”. In the end the Labour Party defeated all Conservative opposition and all private, charitable and local healthcare had its ownership taken by the government. 

Newspaper Cartoons showing the opposition to the NHS by doctors

A date was set for July 5^th 1948 as an official opening to the new medical service for all.

Once created the new NHS was a huge organisation and instantly became Britain's 3rd largest employer.  In 1948 the health service employed 364,000 staff across England and Wales. The report of the Ministry of Health in 1952 showed that when it started the staff included 9,000 full-time doctors and 149,000 nurses or midwives.

A newspaper clipping showing the starting day of the NHS 

New happy patients being treated 

Demand was also high from the get go. At the beginning the National Health Service provided all treatments for free. By 1950 it had become apparent that there would be funding problems due to spending exceeding even the highest forecasts. There was many incidents of “dandruff costs” where people would visit doctors and hospitals about “trivial” illnesses and have prescriptions supplied for things such as dandruff shampoo. On top of this Britain entered into the costly Korean War to keep allies, and financiers, the USA happy. Part of the deal for continued American support was an increase in armament spending and thus a budget cut to the NHS. Many US politicians and citizens did not believe that they should “subsidise British healthcare”. Bevan, the original craftsman of the NHS resigned his government position over the imposition of prescription charges.  He felt that it was a betrayal of what the NHS and his Labour Party had stood for.

Milestones of the NHS

From its inception the NHS has helped oversee many ground-breaking discoveries in healthcare whilst also experiencing the benefits that medicine has experienced from incredible worldwide research. Below are some of the discoveries that the NHS has seen change the way people are treated since in began helping the people of Britain in 1948.

1949: Sir Nicolas Harold Lloyd Ridley helped change many peoples lives by inventing the first Intraocular Lens (IOL) - an artificial lens to replace the eye's natural lens. Before this many people experience blindness due to cataracts or other now easily curable optical problems. Now over 400,000 cataract operations are performed each year in England and Wales.

1952: Before the vaccine was created Polio was a death sentence to most people who contracted it. It left many others with incurable lifelong disabilities. The Polio vaccine is one of the greatest medical success stories for collectivised global work against illness.  Cases have decreased by over 99% since 1988 and only 22 cases were reported in 2017 globally.

1953: British scientists Francis Crick and James Watson identified the double helix 3D structure of DNA. Their discovery has revolutionised medicine as it helped in understanding the make up of human bodies, how diseases work and how drugs can target the specific natrue of each unique illness.

1954: Smoking had been a stable part of most peoples lives before the ground-breaking discovery of its links to ill health and causing cancers. British scientist Sir Richard Doll researched into lung cancer in the 1940s later discovering the relationship between cigarettes and cancer.

1958: The government introduced the first mass vaccination programme for the people of Britain. Everyone under the age of 15 was vaccinated against polio and diphtheria in a programme in 1958. Before the vaccinations, cases of polio climbed as high as 8,000 and diphtheria as high as 70,000 in epidemic years, resulting in 5,000 deaths. This changed the way medicine worked. Pre-emptive measures now became part of medical culture to try and stop diseases before they infected people. Now vaccinations are part of people’s normal lives protecting us from preventable illnesses.

1960: The first UK kidney transplant took place in 1960, between identical twins. The procedure is now much more commons with over 3,000 a year. On top of this family members are now no longer needed as a match. Donors can now help those who are in need. Even with big medical advancements there is always extra donors needed for transplants.

1960: British scientist Audrey Smith’s has helped many people have their own families. Smith’s research into the storing of biological materials helped the field of cryobiology. This technology now helps in the freezing of sperm, eggs and embryos to help IVF programmes and for people to successful conceive.

1960: Scientists began extensive trials in the 1960s into radiotherapy as a treatment for a number of cancers. The tests found that radiotherapy was extremely effective in treating people. The technology has helped save many lives and at present radiotherapy is widely used as treatment, with almost 4 in 10 treatments for cancers using it.

1961: Contraception in the form of the Pill became available. Throughout the rest of the decade this medical advancement meant that women’s mental and physical healthy improved as they were given control over their lives. The choice was now down to them about their futures.

1962: The first full hip replacement was carried out by Professor Sir John Charnley. For many years different treatments had been tried to cure problems with hips. Most popular was the fusing technique, although eventually this caused more problems for the spine and partially hindered mobility. In 2018 hip replacements are commonplace and highly successful helping people to walk again.

1970: Manchester doctors discovered the effectiveness of tamoxifen in the treatment of breast cancer. This discovery would help save the lives of many women in decades to come.

1972: Computerised tomography (CT) scanners were brought into usage. This helped doctors look into patients in a way that had not been possible before. The introduction of these machines, and later MRI’s, helped prevent and aid treatment of many previously undetectable diseases.

1996: In the 1980’s AIDs and HIV was seen as a super virus that could not be stopped. The narratives around it led to the castigation of many peoples from society. Thankfully in 1996 a discovery was made about the effectiveness of Highly Active Antiretroviral therapy (HAART). This helped treatment for those diagnosed with HIV. Now the life expectancy of those living with HIV patients has improved by 16 years.