The Birth of the NHS

After a roadside picnic on the campaign trail in 1945 Winston Churchill turned to his aides and said, “I’m going to lose this. I have nothing to offer them.” He was right. The same man who took the lonely stance of continuing the war in 1940 when others wanted to negotiate, who led Britain to survival against odds at which any betting man would scoff and whose military were pounding the Germans into submission alongside the soon-to-be foes of Russia and America was right. After the previous war the British wanted to return to the old ways, now they wanted a fresh start. Clement Attlee and the Labour Party swept into office and begun wrapping their gift for a new age – the National Health Service.

While it is tempting to imagine the colourful NHS rolling out across Britain and crushing the old Victorian Poor Law as men in top hats dropped their monocles into their crystal glasses of armagnac amid warnings of a greedy underclass seizing the means of production – that, somewhat surprisingly, is not the case. The NHS, while revolutionary, did build upon existing systems.

In 1911 David Lloyd George introduced the National Insurance Act which provided medical care, unemployment benefits and a pension to working men in return for weekly deductions from their pay. But the medical care provided a limited service from a doctor and hospital treatment only if suffering from tuberculosis. Local authorities also provided medical care for ratepayers and in 1930 the London County Council took control of 140 hospitals. In short, the system did not work well as it was a mix of different solutions to different problems in different regions.

Necessity breeds invention and the impending war again created a need for the fighting fit. But as the world entered the chasm of total war the ‘fighting fit’ no longer meant men at the front line, it meant the entire population who also required medical care from impending Luftwaffe attacks as well as general health. The medical service, as with almost all services and industry, came under state control. Towards the end of the war as Churchill, Roosevelt and Stalin planned for the post-war world, the Labour Party planned for the post-war Britain.

Published in December 1942 the Beveridge Report proposed huge reform to tackle the five ‘Great Evils’ of society: squalor, ignorance, want, idleness and disease. Needless to say it was hugely popular across the board but the realist Churchill in a broadcast entitled ‘After the War’ warned the public not to impose huge spending on the government without any relation to the, “circumstances which might prevail at the time.” After all in that month Britain suffered huge losses to German U-Boats in the Atlantic as the Russian war effort was badly creaking in the east. These discussions were all well and good but the outcome of the war was far from certain and Britain was surviving day to day on heavy American finance.

But by the following year it became clear that Britain would become a welfare state after the war. It is unclear whether this as a reward for the people’s endeavour since 1939 or as a logical step for a healthy populace in an uncertain age. Regardless, the decision had been made and the general principles of the new NHS were as follows:

  1. Services were to be provided free at the point of use
  2. Services were financed by general taxation
  3. Everyone was eligible for care, even those visiting the country

The structure of the new National Health Service was passed by law in November 1946 and was launched on 5th July 1948. It now took control of 480,000 hospital beds, 125,000 nurses and 5,000 consultants. The introduction of the welfare state could not have come at a better time for the people as rationing, a national housing shortage and spiralling tuberculosis deaths rocked the country after six years of war.

Following it’s introduction, the Minister for Health Aneurin Bevan stated, “This is the biggest single experiment in social service that the world has ever seen undertaken.” Nobody would debate that however how long the experiment will continue to last is up for grabs.

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