Pre-1948 welfare provision and healthcare was patchy and lacked uniformity. Back in the nineteenth century, many people joined friendly societies, which allowed members to put money aside for hard times, such as sickness, unemployment, old age and burial provision. Hospitals were often voluntary and survived on philanthropic funding that was prevalent in the Victorian era. The Poor Law offered relief to the most in need and workhouses had their own hospital provision but the conditions and stigma attached to the workhouse was a major drawback. Into the twentieth century the Liberals, led by Lloyd George, instituted a programme of reform that formed the early stages of a welfare state. They introduced a range of initiatives, including the Old Age Pension Act of 1908 and the National Insurance Act of 1911. Local government also provided a wide range of public health-related services, such as school meals and health education and by the 1930s, it included hospital provision, where many of the hospitals that had been run by the Poor Law were incorporated into local authority control.
Health reform accelerated in consequence of wartime experiences, notably World War Two, since there became an overwhelming need for a healthcare system to cope with both military and civilian casualties. As part of plans for post-war reconstruction the wartime coalition government commissioned a review led by William Beveridge. His 1942 report not only covered health, but provided a blueprint on the future of social insurance and a means to provide a cradle to grave system of welfare provision.
In 1946 the National Insurance Act established a more comprehensive provision for unemployment, sickness, maternity and pensions; and the National Health Service Act intended to provide a universal system of health provision, that was free at the point of use and included dental and eye care. The 1945 election brought Labour’s Clement Attlee to power and he began instituting the finding of the Beveridge Report, including development of the National Health Service.
On 5 July 1948, Health Secretary Aneurin (Nye) Bevan officially launched the NHS at the Park Hospital (now Trafford General) in Manchester. It was founded on a number of key principles, though at its heart its mission was to provide a comprehensive service for all, regardless of status. It was a three-level system of health care – hospitals; general practice, dentistry, and opticians; and local authority services managing preventative and community healthcare. In 1958 vaccinations for polio and diphtheria were launched and subsequent immunisation programmes took this preventative medicine further.
The NHS has witnessed some major medical ‘firsts’, including the first UK kidney transplant in 1960; the introduction of the ‘pill’ in the 1960s; the first heart transplant in Britain in 1968; the first ‘test-tube’ baby born in 1978 at Oldham Hospital; and the introduction of MRI scanners in the 1980s. Its remit ever since 1948 has also had a strong emphasis on preventative healthcare. Campaigns on drugs, alcohol, smoking, diet and lifestyle have been both welcomed in attempts at educating to prevent illness and save the NHS money, yet also criticised for creating a nanny state culture. So one debate that continues to resonate is where does individual responsibility for their health end and the State take over?
One of the biggest challenges the NHS has faced is the cost. It very quickly ran into financial problems and even by 1951, just three years after it began, the Government brought in charges for dental work, glasses and prescriptions. This resulted in the resignation of Nye Bevan, who saw this as an erosion of its founding principles. 70 years later this problem continues.
In 2013 NHS England warned of a £30bn funding gap by 2020 and currently the government has to continually provide short-term funding whilst attempting to develop a sustainable long-term financial plan. On 17 June 2018 the government announced a £20 billion boost by 2023 as a birthday present but is being pressed on the sources of this funding and whether it will lead to tax increases. Current funding priorities focus on maintaining Accident and Emergency services in wake of growing demand and seasonal pressures. General Practice services are also under strain, where a more flexible service is expected but with limited resources. Waiting times for diseases such as cancer, and increasing demand for mental health services also add pressure to an already stretched service.
So how does the NHS face the next 70 years and beyond? Its original concept, whilst admirable, is struggling to cope with the demands placed upon it and is in many respects a victim of its own success. The future of the NHS is one of the most contentious political issues of our time and successive attempts at reform have not provided a sustainable solution in providing a universal system of healthcare for over 65 million people with an increasingly older demographic. However, the NHS and the daily dedication of its staff remains one of the nation’s cornerstone institutions and tribute must be paid to all those that have made it such a success over the last 70 years.
By Deborah Woodman