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Before the National Health Service (NHS) was set up in 1948, access to health care was limited. It depended on people’s ability to pay or on the voluntary facilities they had access to where they lived.

The National Health Service (NHS)

At the start of World War Two, the government realised that the situation needed to change. If it was to cope with the huge number of anticipated casualties, it needed to increase spending on health care. It therefore began to plan for the future. In 1942 a civil servant, William Beveridge, produced a report - known as the Beveridge Report - that proposed a free national health service. It targeted five main areas - ‘giants’ - to improve:

The ‘five giants’ were:

• idleness - caused by a lack of employment opportunities
• ignorance - caused by people lacking a good education
• disease - caused by unaffordable health care
• squalor - caused by poor-quality housing
• want - caused by poverty

When the Labour Party won the general election in 1945, they began to implement ideas from the Beveridge Report. The acts introduced to tackle these ‘five giants’ helped to establish the welfare state.

In 1946, the new Labour government passed the National Health Service Act. The model they used was based on one used in Tredegar, Wales, in the 1930s. This was like an early, local version of the NHS. However, the new Minister for Health, Aneurin Bevan, who was Member of Parliament (MP) for Tredegar, had to work hard to overcome opposition to the NHS. This opposition came from several areas:

• The BMA feared that doctors employed by the NHS would lose income.
• Many local authorities and voluntary bodies that ran hospitals also objected, as they feared they would lose control over the hospitals.
• Many people, such as Winston Churchill and many Conservative MPs, thought that the cost of the NHS would be too great.

5 July 1948

In spite of all opposition, on 5 July 1948, the National Health Service came into being. It was part of a series of reforms that aimed to use money from taxes to provide support “from the cradle to the grave”. In terms of health care, the NHS brought many changes to Britain’s health system. These included:

• free medical treatment for all British citizens
• the nationalisation of hospitals under the Ministry of Health
• the creation of health centres to provide services such as vaccinations, maternity care and district nurses
• a better distribution of doctors around the country, with GPs (general practitioners), opticians and dentists in every area

The NHS since 1948

Since its creation in 1948, the NHS has made a major contribution to the quality of health care and life expectancy in Britain. However, its successes - particulary in raising life expectancy - have in turn helped to create the pressure of increased demand on its services.

Successes of the NHS

• The NHS has made health care accessible to all members of the public.
• The NHS has made a major contribution to increasing life expectancy in the UK.
• There has been a continuing reduction in child mortality and maternalmortality rates.
• There have been major medical breakthroughs in many areas, eg transplant surgery and cancer treatment.
• A wide range of services have been made available, eg cancer screening and asthma clinics.
• There has been an increasing emphasis on preventative medicine. Examples include mass vaccination against a variety of illnesses, and health campaigns, eg to reduce smoking.
• The NHS has helped to reduce the pressure to care for the sick that many women felt when acting as main carers.

Problems facing the NHS

• Since the NHS’s founding in 1948, the cost of providing care has increased, putting pressure on its budgets.
• The NHS is no longer completely free. As early as 1952, prescription charges were introduced. Since then, charges have been introduced for other services, eg eye tests and dental treatment.
• There are now waiting lists for many operations.
• Some people have been refused costly services and medicines.
• As life expectancy has increased, so an ageing population has put greater pressure on the NHS.