The Foundations of the British National Health Service
The British National health Service came into being in 1948. The NHS did not, however burst forth from the forehead of Clement Attlee, as Athena was given birth by Zeus. The building blocks of the NHS were in place at the end of World War II, but the health care system in place at the time was a patchwork of competing and overlapping services and providers in some areas and a lack of access to medical care in others.
In July, 1945, before World War II ended with the final defeat of Japan, Britain elected a Labour government. This election result was largely explained by a demand for social reform that had grown in the U.K. during the war. Health care reform was at or near the top of the new government’s agenda and in 1946 it passed the National Health Service Act. There was a consensus in Parliament and within the nation that reform was necessary. The debate was about what reform would mean. Several interest groups, most physicians for example, were opposed to the NHS, but Labour had received a very strong mandate to proceed in that direction. In 1948, the British Government created the National Health Service.
Before 1948, low wage workers could receive free medical treatment from a General Practitioner. The wives and children of such workers, as well as better paid employees and retired people, had to pay for a GP’s care. Sometimes the poor would receive treatment through the charity of their doctor. The NHS Act provided that all residents of the U.K. would be part of the new system and that everyone would enter the system through one of the existing General Practices. Instantly, then, everyone in Great Britain could see a General Practitioner for free.
The sector of the British health care system most in need of reform
were the hospitals. Many hospitals were in very poor financial
health and many had been damaged by wartime bombing. Every hospital
in London had been damaged by German bombs.
The most prestigious hospitals in Britain at the time were so called “voluntaries” or voluntary hospitals. These varied widely in financial resources, admission practices and mission. Some were small hospitals in smaller towns, supported by public subscription. Others were world renowned and wealthy, famous for teaching doctors from around the world. A few had been founded in the Middle Ages but most were not quire so old. Some hospitals had developed in association with universities and medical schools. Some hospitals concentrated on particular diseases like tuberculosis and some treated only certain kinds of patients, like women or children.
County and municipal authorities operated most of Britain’s hospitals before the NHS came into being. In 1948, 150 local governments bore some level of medical responsibility. Maternity hospitals, geriatric hospitals, hospitals specializing in infectious disease, and psychiatric facilities were operated by local governments.
While such facilities were provided by local authorities, there was no national standard governing them. Like the voluntaries, each local board or council decided how its hospital was governed. Every council that provided medical services had a Medical Officer of Health (MOH). Health Officers administered midwifery and child welfare programs. MOHs also oversaw food and drug safety matters.
Some municipalities provided services mandated by the Poor law. Poor Houses lost their Dickensian titles in 1929 when they became Public Assistance Institutions. Their function did not change, and they still provided indigent seniors with a place to live. The NHS provided for improved medical care for the residents of these institutions.
Bethlehem Royal Hospital was the first hospital in Great Britain to
specialize in the treatment of patients with mental illness. The
word ‘bedlam’, meaning noisy and chaotic disorder, is derived from
its name. Bethlehem is emblematic of the way psychiatric patients
were treated until recent time. In 1948, the NHS inherited all
institutions for the mentally ill, most of them housed in grim and
The National Health Service was built on the foundation of the
health care system that existed in the United Kingdom at the end of
World War II. The infrastructure of that system had damaged in the
war and inconsistent funding meant that maintenance often did not
occur. At the same time there were hospitals and other facilities in
every city and in most towns. Britain had and has a first rate
education system that produced many brilliant and dedicate
physicians and surgeons. Nurses provide much of the direct patient
care, but standards varied from facility to facility. Britain began
to address its health care issues with the passage of the National
Health Service Act, building on an extensive system that had grown
up over many centuries.