NHS at 72: How was the health service created and what were its guiding principles?

The NHS celebrates its 72nd birthday on 5 July.

Officially launched with the opening of Park Hospital in Manchester (now Trafford General) by the Labour health secretary, Aneurin Bevan, in 1948, this huge undertaking was designed to bring all UK healthcare providers together under one administrating organisation, offering “cradle to the grave” medical treatment for all – free at the point of delivery.

Crucially, the health service would be funded entirely by tax contributions, meaning that people would pay for its upkeep according to their means. No one would be left behind, priced out of care or left at the mercy of insurance premiums.

Prior to the creation of the NHS, healthcare in Britain presented a fragmented picture, administered by a patchwork of private and municipal schemes of wildly varying quality, with the charity sector stepping in to pick up the slack and all too reliant on philanthropy.

A relic of the Victorian era hardly fit for purpose, the wealthy were well catered for but poverty and deprivation were rife among a working class excluded from fundamental necessities by exorbitant costs.

Dr Benjamin Moore, a physician from Liverpool who founded the State Medical Association, is credited with coining the phrase “National Health Service” in his 1910 book The Dawn of the Health Age, which recommended a system of state medicine in which consultant physicians functioned like policemen, suppressing disease as officers tackle crime.

An early gesture towards improving the lot of working people came when chancellor of the exchequer, David Lloyd George, introduced the National Insurance Act 1911, which saw the automatic deduction of a small amount of an employee’s weekly wages in exchange for access to medical care, for which registration with a doctor was required.

During the First World War, the British Army demonstrated the value of organised medical care in its support for frontline soldiers injured in combat.

Sir Bertrand Dawson was subsequently commissioned by the Liberal health minister, Christopher Addison, to chair a council advising on how a systematised health service might be implemented at a national level.

The civil servant’s forward-looking Interim Report on the Future Provision of Medical and Allied Services 1920 was published in May 1920.

“The insufficiency of organisation has become more apparent with the growth of knowledge, and with the increasing conviction that the best means of maintaining health and curing disease should be made available to all citizens,” Lord Dawson concluded.

The peer went on to outline a structure which would see patients’ treatment beginning in a doctor’s surgery before being continued at either a primary or secondary health centre, depending on whether preventative or more specialist care was required.

Lord Dawson’s committee stopped short of advocating free treatment, fearing such a measure would be too large a drain on the public purse.

Sir Bertrand’s prescriptions were not enacted due to the subsequent fall of the Lloyd George government, but local authorities did assume responsibility for Poor Law hospitals under the Local Government Act 1929 at the end of the decade.

The London County Council, for instance, took charge of 140 hospitals from the abolished Metropolitan Asylums Board.

In the 1930s, the British Medical Association, the Hospitals Association and several think-tanks all produced reports calling for reform and arguing for greater co-operation between regional healthcare providers to ensure greater cohesion and efficiency.

The Labour Party accepted Somerville Hastings’ resolution backing the establishment of a state medical service in 1932.

Arguably the popularity of Dr AJ Cronin’s novel The Citadel (1937) had much greater influence, helping to open up the public debate about medical ethics.

The book, inspired by its author’s experiences as a GP caring for the coal mining communities of the South Wales Valleys, chronicled the injustice, poverty and silicosis Dr Cronin encountered in the town of Tredegar.

“The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system,” he explained.

With the outbreak of the Second World War, the introduction of the state-run Emergency Hospital Service in 1939 gave a foretaste of things to come.

Another founding influence was Sir William Beveridge, whose Social Insurance and Allied Services report of 1942 paved the path for the modern welfare state by identifying the “five giants” that needed to be slain before Britain could enjoy true social prosperity: want, disease, ignorance, squalor and idleness.

Though Sir William himself was no socialist, he believed relieving working people and businesses of healthcare and pension costs would advance the competitiveness of British industry and produce a healthier, happier workforce.

Collective commitment to eradicating the social ailments he had diagnosed would bring rewards for all, he argued.

Inspired by the Beveridge Report, the Conservative health secretary, Henry Willink, issued a white paper in 1944 at the height of the war proposing a framework for national health provision which contained several core principles of the NHS: services free at the point of use, financed by central taxation and open to everyone.

Mr Willink was never given the chance to implement his plan, which provoked fiery opposition from fellow Tories, as Clement Attlee’s Labour Party stormed to victory in the 1945 general election, ousting victorious prime minister Sir Winston Churchill.

Aneurin Bevan, Mr Attlee’s youngest Cabinet minister at 48, was appointed to pick up the baton from Mr Willink.

Disagreeing with his predecessor about the ability of local authorities to run hospitals, Mr Bevan concluded: “The only thing to do was to create an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service.”

The National Health Service Act of 1946 received royal assent on 6 November, 1946, and the NHS was born.

The Attlee administration’s ambitions for democratic socialism and the welfare state, tackling Mr Beveridge’s “five giants” with fearlessness, daring and compassion, were symptomatic of an extraordinary moment of consensus and unity, perhaps unique in British history.

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Created with Sketch.

The “Spirit of ‘45”, the national mood of optimism which swept post-war Britain following VE Day, indicated a sincere belief a better, fairer society could be built from the rubble of the Blitz.

The Attlee government’s successful bid to rake in funds for the welfare state by targeting rich business owners with tax increases – redistributing the wealth it felt had been generated by workers in the first place – is hard to imagine being implemented without a fight in the current climate.

But as Mr Bevan wrote in his 1952 book In Place of Fear: “The collective principle asserts … no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

Source: UK Politics - www.independent.co.uk