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NHS at 70: how Bevan's announcement transformed the UK

On its anniversary, we should reflect on all that the health service has achieved

On its anniversary, we should reflect on all that the health service has achieved


A boy being treated through the plastic sheeting of the earliest attempts at reverse barrier nursing in 1973 when bone marrow transplantation was started for cases of acute leukaemia

On July 5 the NHS will be 70 years old.

It is an anniversary worth marking as very few of us have known, or could even imagine, a health service that you have to pay for. It is timely we should reflect on what has been achieved and what we often take for granted.

Before the NHS came into force in 1948, the quality and type of healthcare that was available in the UK depended on geographical location and social class. The wealthier sections of society could access private medicine, while those with limited resources were dependent upon a haphazard mix of private, municipal and charity schemes.

Three types of hospitals existed before 1948. The first group was called public health hospitals: these included maternity hospitals and infirmaries for infectious diseases, as well as public assistance institutions. Often former workhouses, caring for large numbers of older people and the chronically ill, and asylums housing people with mental health issues, also came under the banner of public assistance institutions.

The Royal Marsden

The Royal Marsden was the first hospital in the world dedicated to the study and treatment of cancer. The Free Cancer Hospital, as it was known then, opened its doors in 1851. It was started by Dr William Marsden with 12 of his friends and supporters. Dr Marsden is known to have said: ‘Now gentleman, I want to found a hospital for the treatment of cancer, and the study of the disease, for at the present time we know absolutely nothing about it.’

When the NHS was formed in 1948, The Royal Marsden became a postgraduate teaching hospital. In response to the need to expand to treat more patients and train more doctors, a second hospital in Sutton, Surrey, was opened by Her Majesty Queen Elizabeth II on 20 May 1963.

There were also voluntary hospitals, including cottage hospitals (a building in a village with hospital beds) and teaching hospitals, which were maintained by public subscription or charities and managed by boards of volunteer governors. These focused on specific categories, such as children or women, and also on particular diseases, such as circulatory and respiratory conditions.

Charitable donations

An example of this is The Royal Marsden, founded in 1851. It was the first hospital in the world dedicated to the study and treatment of cancer. Treatment was given free of charge to those who needed it and was funded by charitable donations. After the formation of the NHS, The Royal Marsden became a postgraduate teaching hospital.

Finally, there were private clinics and nursing homes. The hospital’s system was complemented by a network of general practitioners who were self-employed. Nurses were directly employed by, and accountable to, the various hospitals.

In 1948, the Labour government introduced a system of universal healthcare, funded directly through taxation. This initiative came as a response to the Social Insurance and Allied Services report (1942) by Sir William Beveridge, which called for comprehensive healthcare as part of a post-war plan to promote education, employment, housing, and social security. 

    The report formed the basis for the post-war reforms known as the Welfare State, which included the expansion of National Insurance and the creation of the NHS.

    Key principles

    When the minister of health, Aneurin Bevan, announced the formation of the NHS, he facilitated the redistribution of resources from richer to poorer areas, making it a truly national system of health. 

    Social Insurance and Allied Services

    The Social Insurance and Allied Services report, commonly known as the Beveridge Report (after its chairman, Sir William Beveridge), was published in 1942. It proposed widespread reforms to the system of social welfare to address the five ‘giant evils’ in society: squalor; ignorance; want; idleness; disease

    The equitable nature of the system was founded on the three key principles: that healthcare would be free at the point of use, available to everyone who needed it, and paid for out of general taxation.

    The introduction of the NHS was not without controversy and was not universally welcomed, but the impact of the new service was a huge boost to a population reeling from the effects of the war.

    To know that ‘no mother in the country need consider whether she can afford to have a doctor for her sick child before calling one in’ and that the new health service would protect the public ‘from before birth to the grave’ paved the way for a new era for society.

    Today, the NHS still enjoys huge public support with 77% of the population indicating that it should be maintained as it is (Kings Fund 2017). The popularity of the NHS makes this anniversary an event worth celebrating.

    Aneurin Bevan

    Aneurin Nye Bevan (1897-1960): a Welsh trade union official and politician, the son of a coal miner, who was MP for Ebbw Vale and later progressed to become Minister for Health.

    He was a determined and fluent negotiator and while being principled, understood the importance of compromise in the protracted discussions that led to the founding of the NHS.

    Reference

    The Kings Fund (2017) What does the public think about the NHS?

    Sir William Beveridge (1942) Social Insurance and Allied Services


    Natalie Doyle is a nurse consultant, living with and beyond cancer at The Royal Marsden Hospital

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