Why was the NHS Created?

This essay will outline and discuss the creation of the National Health Service in England. It will focus on the events that contributed to the creation and development of the National Health Service. It will also investigate the extent that it was also opposed.

The National Health Service was not as spontaneous and revolutionary as many historians had originally believed, as its origins and beginnings stretched back as far as to the eighteenth century. ‘..voluntary hospitals[…] the sanitation revolution of the mid- nineteenth century […] and the first public housing, accompanied by the provision of isolated hospitals for smallpox and other infectious dieases.’ [1] These voluntary hospitals were the first types of medical institutes for the general public whereby groups of ill people would go to escape their everyday lives to try and recover from their illnesses. However the voluntary hospitals were not always easy to be admitted in to, which would have been very unnerving for the sick. ‘ …voluntary hospitals could usually only be obtained by presentation of an order from a subscriber or governor.’ [2] This also meant that many people that needed medical treatment did not have access to it and thus had to turn to other types of treatment. The nursing profession was not highly respected at this time because of the jobs that it involved. There was also bad sanitation in these hospitals meaning that even if people were admitted there was a chance that they would die as a result of bad sanitation and not their illness alone. It was also at this time that there was an increase in the population of England, the voluntary hospitals did no cope with this increase well as they were under great strains because of this.

The National Health Service (NHS) was formed in 1948. It initially advocated free medical care for all citizens of Britain regardless of wealth or class from the cradle to the grave. Its original structure consisted of a hospital service, primary care service as well as community services. However before the NHS was set up the majority of the population were required to pay for any medical treatment or care that they needed, this was problematic as the lower class citizens of Britain in particular found the price of these medical treatments increasingly difficult to pay for. This meant that they had little choice as to what they could do, they could either pay for the treatment which would mean that their household would be even worse off financially or to find other ways of treating their illness themselves. Even if they decided to pay for treatment, for serious illnesses’ it would have been unlikely that they would have survived, thus meaning that it was not always a wise choice to pay for their treatment.

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When the NHS was still only a theoretic idea, many people knew that something had to be done with the state of medical care and provisions within England. It was not until 1930 when the Poor Law Act was introduced that many of the poor were merely just sent to dispensaries to buy their medicine, which meant that the patients had no relationship with their doctor and were also not allowed a choice of doctor. This would have effected a lot of people as a relationship with their doctor would have been extremely important to them, more so if they were required to have on going treatment. Also for the medical profession, it would have been important for them to see the same patients to help with the effectiveness and reliability of medical care that the patients needed.

The Poor Law Act was an important legislation that was passed as the health of the lower classes was incredibly bad until this time, and they received no health care benefits. ‘Some attempts were made to alleviate sick paupers by outdoor relief and the attendance of parish doctors, but most Boards of Guardians found it cheaper and more convenient to admit them to a workhouse.’ [3] However this became difficult to conduct as too many people were being admitted to these workhouses. Even though the paupers were probably still able to work being in such a place would have been more detrimental to their health because they were not actually getting the medical attention they needed. ‘In 1834 about 10,000 workhouse inmates needed medical care and the number had risen to over 50,000 in 1861.’ [4] 

The Boar War (1899-1902), World War One (1914-1918), as well as World War Two (1939-1945) could be said to have acted as a catalyst in the creation of the NHS. As the Boar war commenced, it was only too evident to the government how ill and unfit the British men were. Recruitment agents had to turn away the majority of men that came forward for the army as they were too unwell for the demands that the army would have put on them. ‘…rejecting about 60 per cent of military volunteers on grounds of stunted growth, rickets, poor eyesight, deformities and weight’. [5] The conditions outlined were the result of malnurishment and was preventable. Fresh air, exercise and diet were seen as the best ways to elimate such conditions. The Government realised that they had to take measures to ensure that the health of Britain improved, as the country would not be able to perform well in war especially as Britain was a leading power in the world. As another way to help conquer these problems the Labour government implanted free school meals and milk for school children during the second world war.

The National Health Insurance Act was introduced by Lloyd George in 1919. He wanted to make sure that lower paid workers were for the first time able to receive medical care. From this moment forward a large range of legislations were passed in relation to and in preparation for a health system for all.

It was not until 1929 as part of the Local Government Act, that poor law hospitals were replaced with municipal hospitals that could only be used for taxpayers and paupers were no longer welcome. These hospitals were far from being sophisticated and luxurious, in fact they were no better than poor law hospitals. Many of the larger councils such as London were doing well as they had a constant flow of patients mainly due to larger numbers of people located in the city than in the rural areas, however this was not the case for all councils around England. A large number of the smaller councils were struggling with finance issues, as they were located in rural areas whereby there were not enough patients to use the service and make it efficient. The King’s Fund and the Nuffield Provincial Hospitals Trust, as protectors of hospitals realised that there was a problem that they these hospitals would not survive until they became more efficient.

It could be argued that the on-set of world war two contributed to the formation of the NHS. It was important for military casualties to be treated effectively whilst Britain was at war. As a result of this the Emergency Medical Scheme (EMS) was set up in 1939 in anticipation of the major casualties that would be present during war time. The EMS was originally responsible for the casualties of servicemen at war. Hospitals were set up to cater for different kinds of injuries such as fractures, and those requiring plastic surgery and burns. However as the number of civilian casualties rose, the scheme extended its service to cater for victims of war such as those injured in domestic blitz attacks, as there were not as many military casualties as was expected. It was at this time that voluntary hospitals were thriving, however in the war years this posed a problem, as the hospitals began to find it increasingly difficult to get funding. They were also located randomly around the country, thus meaning that many ill patients were not able to be treated. The experience that was gained by the formation of the EMS was used as an example of what could be achieved. It could therefore be said that this was one of the first ideas and positive movements towards a national medical service.

It was Walter Elliott, the present minister, who first suggested that government should look at a state run hospital service, rather than the Emergency Hospital Scheme which they already had.

The Beveridge report was released on 1st December 1942, this focused on social insurance and allied services. Beveridge wanted to ensure that the people of Britian were well cared for and no longer confined to awful conditions. The main ideas in this report outlined the beginnings of a welfare state, he also believed that the Government should eradicate the ‘Five Giant Evils’ of Want’, Disease, Ignorance, Squalor and Idleness.’ [6] It was to be fully financed by insurance contributions, however private treatment would still be available. It was in this report that Beveridge proclaimed the need for a health service, however he was not precise and no detailed plans were explained.

It has been argued that idea of this report becoming implemented resulted in a landslide voting for the Labour party in the 1945 elections. People believed that it would be a success and were eager for it to be introduced. However this changed notions of ‘laissez faire’.

Clement Atlee was elected Prime Minister after the Labour Party defeated Winston Churchill’s Conservative Party in 1945. It was at this time that Atlee implemented the idea of the Welfare State, which included a National Health Service and Social Security. The Minister of Health Anuerin Bevan was appointed the role of conducting the service. A National insurance scheme was also set up by Lloyd George in 1911. People in work still had to make contributions each week, as well as employers, but the benefits provided were now much greater.

When the NHS was finally started on 5th July 1948 as part of the National Insurance Scheme, The English society had just come out of a major war and were therefore used to having little and thus were content with the simplicity of the health service and saw it as an improvement.

The NHS advocated many sanctions including, free general practioners and patient care for all, nationalisation of hospitals, as well as the capitation of general practictioners. It was funded entirely by public taxations. This was a great relief for the poor. ‘The poor gained access to doctors and a range of treatments previously beyond their means, and no longer needed to worry economically about illness or injury’. [7] However this soon changed in 1951 when charges were imposed for prescriptions, teeth and spectacles. There were many successes as well as failures with the NHS as a whole. It promoted medical technology and advancement of drugs such as penicillin which on the other hand was over used during this period. Infant mortality was reduced as a result of women being able to give birth in clean sanitised areas. There were no longer restrictions for who could be treated. However, the NHS had many problems with finance as overspending was a regular occurance. ‘The NHS budgeted for one million pounds for opticians, but within a year 5.25 million spectacle prescriptions…’ [8] 

There was much opposition to the National Health Service even before it was officially set up. Doctors in particular were deeply displeased, they were worried that as a result of standardisation they would ultimately lose money for their profession. Many of the medical professionals relied on visiting private patients and were not treating people in the hospital. Margret Grieve a midwife worked in Dumfries she explained why the other doctors were concerned with a move towards a universal service. ‘”…there was apprehension about being employed by the government. I remember the consultants talking about it. Most of them earned only a pittance from their hospital work, so they depended on private patients for their living, and they were afraid of losing that. The private patients did not want it either. But the ones coming back from the war were happy with the NHS, because they did not have the private patients.”‘ [9] The BMA (British Medical Association) believed that the move towards a salarised service would pose a threat to clinical freedom. The BMA were serious about what they believed and made a stand. They told their members not to conform to the Act, and asked them to sign a petition in agreement that they ‘…would refuse to serve until the government accepted almost conditions put forward by their council.’ [10] The BMA were probably the most powerful organisation to oppose the NHS as without doctors, the NHS would not have been able to run and ultimately survive.

‘The Minister of Health said that, until the autumn of 1947,there had been some prospect that the medical profession as a whole would willingly accept the scheme for a National Health Service, and many leading members of the profession were still favourably disposed to it.’ [11] There was conflict between the medical professions and government up until the NHS act was passed in 1948, in April of the same year it looked unpromising that the doctors would even join. ‘Doctors’ representatives and most Tory policitians sought secure funding for hospitals, but were unwilling to see the prestigious charity hospitals subordinated in an extension of local authority services.’ [12] 

‘Only the most senior doctors in hospitals (consultants) were allowed to continue private treatment.’ [13] Churches and Charities also feared that they would be forced to become nationalised and would become inclusive of the NHS plans.

However in due time the BMA had no choice but to release its’ members from their agreements as the professionals had began joining the NHS, had resigned from the BMA and therefore were not taking any notice of the BMA advice. ‘Resignations from the BMA increased every month during the second half of 1912.’ [14] Bevan had to compromise a lot for the BMA, he allowed GP’s and consultants to continue to run their private practises as well as an increased salary for consultants and nurses. The professionals also began to realise that by not going the NHS they would become less financially stable. Bevan did all he could do and gave them offers that they could not refuse. “I stuffed their mouths with gold.” [15] In effect Bevan compromised with the BMA, by making the NHS sound appealing to them.

However the Conservation party also were not fully accepting of the service and the labour party were also divided over the direction of a health service, Herbert Morrison believed that the service should not be run by the government but by the local councils. However this went against what Bevan was advocating, as it defeated the object that the service was to be universal.

There was not necessarily a lot of opposition to the National Health Service, but the main opposition being the BMA was the largest and the most significant, as without professionals it would not have been able to function. Bevan saw this as a challenge.