NHS at 75: The story of the foundation of the health service

As befits such occasions there were smiles all round, and with good reason - here at last, was a health service free at the point of use, and available to all.

The idea of such a universal service for Britain had been decades in the making, and through the 1930s it had gathered support and momentum among the medical profession and in political circles.

The prospect and then the reality of war stalled the introduction of such a service.

But while the Second World War both delayed the legislation and denied the resources required to make any sort of national health service happen, it necessitated the creation of a system - the Emergency Hospital Service - that provided a tantalising glimpse, albeit under extraordinary circumstances, of how such a service might work.

It may also be argued that the heavily regulated and restricted lives of people in Britain during the long years of war, made many among a severely tested population more accepting of state control of a whole range of key services as post-war rebuilding began.

This began to happen through the nationalisation programme ushered in under the Labour Government after it was swept to power in the General Election of July 1945.

New Prime Minister Clement Attlee’s appointment of Bevan as Minister of Health in that election’s aftermath, meant the task of developing a national health service fell to the Welshman.

Some three years later he duly delivered it, but only after prolonged and bruising behind-the-scenes battles - with his fellow ministers, with the Conservative Opposition, and with a hugely sceptical medical profession.

The seeds for a national health service had already been sown, in the midst of the war, and during a year - 1941 - when the Nazi threat remained immense.

Remarkably however, plans were being made for a future free of that threat and the chaos of war - and they included a post-war social policy which proposed a health service available to all.

By October that year, then Minister of Health Ernest Brown announced a Government proposal to create a free hospital service, to be run by local authorities.

The following year a Medical Planning Commission, set up by professional bodies, recommended that a national health service be created, with GPs working at health centres and hospitals run on a regional basis.

This was largely the same model as proposed in the Beveridge Report, published late in 1942.

The British Medical Association however, had other ideas. In 1943 it changed its policy and began to oppose the idea of local authority control of hospitals. Instead, it proposed that health insurance be extended.

Henry Willink, Brown’s successor as Minister of Health, put together a White Paper proposing a national health service, a document subsequently backed and published by the Cabinet of the day, despite feverish opposition from some quarters.

The White Paper laid the foundation stones for the NHS, proposing that a free at the point of use service be funded through general taxation instead of national insurance.

The 1945 election relieved the Conservative Willink of the task of trying to persuade doctors to accept the idea.

While not exactly tearing up the blueprint, Bevan came to the conclusion that it needed a radical overhaul.

Believing that local authorities were too small to manage hospitals, he instead proposed the creation of what he described as “an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service”.

On November 6 1946, the Royal Assent was given to the National Health Service Act that adopted Bevan’s vision.

The arguments had begun well before that autumn however.

Indeed, from spring 1946 when Bevan’s White Paper proposing an NHS had been published, until just weeks before the NHS was born, the knives were out.

Bevan needed Attlee’s backing for his proposal in the face of determined opposition from his Cabinet colleague, deputy prime minister Herbert Morrison, while the Winston Churchill-led Conservative Opposition was vehemently opposed to Bevan’s vision, and fought it all the way through the House of Commons.

The medical profession meanwhile was, until just weeks before the service started, implacably opposed, fearing a loss of freedom and alarmed at the prospect of becoming servants of the State.

As late as April 1948, despite amendments proposed by Bevan, BMA members voted resoundingly not to join the NHS, but he managed to bring them on board, just weeks away from its launch.

While privately unhappy at having to make concessions to sway the profession, Bevan managed to do so while preserving the fundamental principles of his blueprint for the NHS.

He later admitted however, that in order to secure the support of medical profession he had “stuffed their mouths with gold” through the offering of a contract that, among other attractions, enabled doctors to continue with private work.

In his book In Place Of Fear, published in 1952, Bevan wrote of the idea of a national health service: “The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

In the book, he also claims that: “Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.

“But private charity and endowment, although inescapably essential at one time, cannot meet the cost of all this. If the job is to be done, the state must accept financial responsibility.”

By the time In Place Of Fear was published however, Bevan had resigned - in April 1951, from the soon-to-be ousted and irrevocably split Labour Government - in protest at the introduction of prescription charges for dental care and spectacles.

This was a battle he lost with the then Chancellor of the Exchequer Hugh Gaitskell, as the huge demand for health services meant that costs far exceeded those predicted at its inception, and a cap was placed on NHS spending.

The service Bevan steered into existence however, remains at its core the same as that which he announced to the world in Manchester 75 years ago.