The formation of the NHS

Ever since the publication of the White Paper, Equity and Excellence: Liberating the NHS in 2010, England's National Health Service (NHS) has been going through something resembling a second gestational period.

Rather than continue to grow and adapt to its ageing self, this heralded single-payer health system (described as the only real religion left in the UK) has retreated to the womb to redevelop and be reborn into a combination of Health Secretary Andrew Lansley's original vision of choice and competition and a very vocal opposition debate, eventually represented by the Future Forum's advice and recommendations.

With both chromosomes still battling it out for dominance, however, the immediate future of the NHS is still uncertain, with a rather troubling child to be brought up by its adoptive parents of GPs, nurses, pharmacists, managers and patients.

Its original inception 63 years ago was not that easy a birth either, with the National Health Service Act 1946 taking two years to travel through parliament before being passed on July 5, 1948, with a provision to 'secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness and for that purpose to provide or secure the effective provision of services.'

Overseen by the Health Minister, Aneurin Bevan, the creation of an NHS in each UK nation was a pivotal part of the social welfare reforms identified by the great reformist William Beveridge and implemented by Clement Atlee's Labour government following the party's landslide victory over Winston Churchill's Conservatives in 1945.

It was a welcome and vital addition to the country for millions, with the UK healthcare system at the time relying significantly on charities and volunteers, as upfront hospital charges for services and the limitations of workers' health insurance (it did not extend to wives or children) meant much of the poorer population went without medical treatment.

Countries elsewhere in Europe at the time had universal systems of healthcare, with Germany implementing arguably the world's first in the late 19th century, with mandatory health insurance that applied initially only to low-income workers before gradually expanding to cover most of the population. However, the NHS was the first completely free healthcare system made available on the basis of citizenship rather than the payment of fees or insurance premiums.

It was a thought reflected in the three main and lasting aims of the service, as written in its constitution:

• that it meet the needs of everyone
• that it be free at the point of delivery
• that it be based on clinical need, not ability to pay.

“But after today the weak will be entitled to clamour,” said Bevan at a speech to the Manchester Labour rally on July 4, 1948, the day before the original Bill was passed.

Opposition to the creation of the NHS existed, however, coming from the Conservatives who had produced their own healthcare White Paper in 1944 under Health Minister Sir Henry Willink, as well as from Bevan's fellow Labour politicians. These included deputy Prime Minister Herbert Morrison and deputy health minister Sir Arthur Rucker, who offered resistance to Bevan's decisions to bring all existing hospitals, including local authority, voluntary, teaching and cottage, into public ownership.

In addition, as with the present Health Bill, the British Medical Association (BMA), the body representing the UK's doctors, was also vocal in its criticisms of the 1946 plans. Although in agreement with the NHS' ambitions, members of the BMA had concerns over the lack of consultation with doctors from ministers, as well as administration methods to implement the health service.

Consultations were had and concessions from the government were made, however (sound familiar?), and the NHS came into being.

Sixty years on, the NHS remains a loved and respected service even as it tries to adapt to a radically different healthcare landscape from when it was conceived.

Priorities have moved from the acute care of infections, accidents and diseases in the developed world to managing long-term conditions, plus integrating healthcare with social care and public health with increasingly expensive technology and products with ever more limited money to spend. It is something the NHS, and indeed healthcare systems in every country, is learning to deal with. A rebirth may be
unnecessary for the challenge, but when looking at what a health service should do, it is worth taking into account the reasons for its existence in the first place.

The Author
Tom Meek, assistant web editor at PMGroup.