History of the National Health Service

The National Health Service (NHS) of England and Wales was founded by the National Health Service Act 1946.

The present article covers the history of the NHS up to the period of reforms under the government of Margaret Thatcher.

Prehistory
Before 1948, when the original three National Health Services were created, patients were generally required to pay for their health care. Free treatment was sometimes available from teaching hospitals and charities hospitals, such as the Royal Free Hospital. Some local authorities operated local hospitals for local ratepayers (under a system originating with the Poor Law), but provision was patchy and quality of care varied greatly.

Systems of health insurance were relatively undeveloped, and usually consisted of private schemes such as Friendly Societies. Under the National Insurance Act in 1911, introduced by David Lloyd George, a small amount was deducted from weekly wages, to which was added contributions from the employer and the government. In the Highlands and Islands a  Medical Service was effectively provided with a free state medical service from 1912 because the population were too poor to pay their contributions.

In return for the record of contributions, the workman was entitled, apart from retirement and unemployment benefits, to medical care, though not necessarily to the drugs prescribed. To obtain medical care, he registered with a doctor. Each doctor who participated in the scheme thus had a 'panel' of those insured under the system, and was paid a capitation grant out of the fund calculated upon the number. (Lloyd George's name survives in the "Lloyd George envelopes" in which most primary care records in England are stored, although today some working records in primary care are at least partially computerised). This imperfect scheme only covered certain trades and occupations, and was known as 'Lloyd George's Ambulance Wagon'. Moreover, due to cuts during the 1930s, many were unable to obtain treatment.

Origins of NHS
In the aftermath of the Second World War, Clement Attlee's Labour government created the NHS, based on the proposals of the Beveridge Report, prepared in 1942. A White Paper was published in 1943 and was followed by considerable debate, and resistance organised by the British Medical Association. The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act) and the new arrangements were launched on 5 July 1948. This was under health and housing minister Aneurin Bevan. Contrary to popular belief, the founding principles of the NHS called for its funding out of general taxation, not through national insurance.

Services would henceforth be provided by the same doctors and the same hospitals, but: The original structure of the NHS had three arms:
 * services were provided free at the point of use;
 * services were financed from central taxation;
 * everyone was eligible for care (even people temporarily resident or visiting the country).


 * 1) Hospital Services - 14 Regional Hospital Boards were created in England and Wales to administer the majority of hospital services. Beneath these were 400 Hospital Management Committees which administered hospitals. Teaching hospitals had different arrangements and were organised under Boards of Governors.
 * 2) Primary Care - GPs were independent contractors (that is they were not salaried employees) and would be paid for each person on their list. Dentists, opticians and pharmacists also generally provided services as independent contractors. Executive Councils were formed and administered contracts and payments to the contractor professions as well as maintaining lists of local practitioners and dealing with patient complaints.
 * 3) Community Services - Maternity and Child Welfare clinics, health visitors, midwives, health education, vaccination & immunisation and ambulance services together with environmental health services were the responsibility of local authorities. This was a continuation of the role local government had held under the Poor Law.

This was known as the tripartite system, which would continue until 1974.

1950 to 1980
By the 1950s, spending on the NHS far exceeded what had been expected by Parliament and the Treasury. Rising costs led to the introduction of a one-shilling charge for prescriptions and a £1 charge for dental treatment, in 1952. With higher prices, these remain the major exceptions to the NHS being free at the point of use. The 1950s also saw the planning of hospital services, dealing in part with some of the gaps and duplications that existed in England and Wales. The period also saw growth in the number of medical staff and a more even distribution of them with the development of hospital outpatient services. However, by 1956 the NHS was stretched financially to breaking point and doctors were disaffected. Indeed, a Royal Commission on doctors' pay was set up in February 1957. The investigation and trial of alleged serial killer Dr John Bodkin Adams exposed some of the tensions in the system. Indeed, if he had been found guilty (for - in the eyes of doctors - accidentally killing a patient while providing treatment) and hanged, the whole NHS would have collapsed. The Mental Health Act of 1959 also significantly altered legislation in respect of mental illness and reduced the grounds on which someone could be detained in a mental hospital.

The 1960s have been characterised as a period of growth for the NHS. In primary care a more equitable distribution of GPs was emerging as was the concept of the primary health care team. The period also saw a growth in health centres. More mental health patients were discharged back into the community and Enoch Powell, who was Minister of Health in the early 1960s, predicted that many of the large mental health institutions would close within ten years. Prescription charges were abolished in 1965 and reintroduced in 1968.Concern also continued to grow about the structure of the NHS and the difficulties of the tripartite system which separated hospital, community and primary care services. A number of papers were published and committees and commissions established in the late 1960s which proposed changes in the structure and organisation of the NHS.

The NHS in England was reorganised in 1974 to bring together services provided by hospitals and services provided by local authorities under the umbrella of Regional Health Authorities, with a further restructuring in 1982. The 1970s also saw the end of the economic optimism which had characterised the 1960s and increasing pressures coming to bear to reduce the amount of money spent on public services and to ensure increased efficiency for the money spent.

Through the 1970s and 1980s, it became clear that the NHS would never get the resources necessary to provide unlimited access to the latest medical treatments, especially in the context of an ageing population. This led to the beginning of a major process of reform, starting about 1980, which is still continuing in 2006.

For history of the service since 1980, see main article National Health Service: - Reforms under   the Thatcher government ''and The Blair government ''

Project

 * WikiProject National Health Service