National Health Service (NHS)
On 5 July 1948 the National Health Service nationalised the hospital service in Britain. This was part of a broad reconstruction programme after the Second World War, which saw nationalisation of many industries and services, including railways, steel, and gas and electricity utilities. These reforms were based on William Beveridge’s 1942 report, which argued that universal access to health care was necessary in order to fight the ‘five giants’ (want, disease, squalor, ignorance and idleness). Beveridge believed that the government should provide its citizens with social security ‘from the cradle to the grave’.
The aim of the NHS was an ambitious one - to make health care available to all based on need rather than the ability to pay. The scheme was financed almost completely through taxation, and care was free to all users - although prescription and dental charges were gradually introduced. It brought together hospitals, doctors, nurses, pharmacists, opticians and dentists in one organisation. The Secretary of State for Health, Aneurin Bevan, was the leading figure in the development of the NHS. Nationalisation of medical care met with resistance from the medical profession, which was worried about professional independence, potential costs and loss of status.
The 1950s were characterised by very low expenditure. More funds were spent on education and housing than on hospital development. In the 1960s government funding was given a boost with the introduction of the Hospital Plan, championed by Enoch Powell. The plan was based on the concept of district general hospitals and was only partially fulfilled. Only a third of the 224 projected schemes were completed, while another third were not even started.
During the 1970s and 1980s, hospitals’ spending was limited to their state allocations, and as a result hospitals up to this period retained many pre-NHS features. Since 1992, most hospital investment has involved the private sector, so that private companies design, build and own services, and lease hospitals to the public sector for periods up to 60 years. However, these developments have come under some criticism. Charges paid to private companies are approximately double what they would have been if paid to the Treasury. As a result, many fear that the largest hospital construction programme will ironically coincide with many hospital closures.
Techniques and Technologies:
D. Gaffney, A. M. Pollock, D. Price and J. Shaoul, ‘NHS capital expenditure and the private finance initiative – expansion or contraction?', British Medical Journal, 319/7201 (1999), pp 48-51
J Mohan, Planning Markets and Hospitals (London: Routledge, 2002)
G Rivett, From Cradle to Grave: Fifty Years of the NHS (London: King's Fund,1998)