A BRIEF HISTORY OF
THE NATIONAL HEALTH SERVICE (Part 1)





Before 1948

We take the National Health Service for granted now, but go back nearly sixty years and health care was a luxury not everyone could afford. It is difficult today for us to imagine what life must have been like without free health care and the difference that the arrival of the NHS made to people's lives.

Just before the creation of the NHS, the services available were, as you might expect, the same as after; no new hospitals were built nor hundreds of new doctors employed. What was different was that poor people often went without medical treatment, relying instead on dubious - and sometimes dangerous - home remedies or on the charity of doctors who gave their services free to their poorest patients.

Hospitals charged

Access to a doctor was free to workers, who were on lower pay, but this didn't necessarily cover their wives or children, nor did it cover other workers or those with a better standard of living. Hospitals charged for services, though sometimes poorer people would be reimbursed. Even so, it meant paying for the service in the first place - which not everyone could afford.

Among the Family History papers I have acquired over the years I have my Grandfather's National Health and Pensions Insurance cars which record his contributions from the 25th August 1928 to 5th July 1936 and show that he made full contributions for each of those years. His contributions were made to the National Amalgamated Approved Schemes who in return would assist him in finding dentists and nursing care, he would also be entitled to 16s (80p) a week sickness benefit. To give you some idea of what that 16s would buy should he have needed to claim it I am also fortunate in having the original Halifax Building Society letter of offer for my grandparents first house which they purchased in 1937 on a mortgage of £475 and which they had to repay at £2-11-9 a month. So the sickness benefit for a month would have been £3.20 against mortgage payments of £2.55 if my pre-decimal maths is correct.

The need for free health care was widely recognised, but it was impossible to achieve without the support or resources of the state.

Philanthropists and Social Reformers

Throughout the 19th century, philanthropists and social reformers working alone had tried to provide free medical care for the poor. One such man was William Marsden, a young surgeon, who in 1828 opened a dispensary for advice and medicines. His grandly named London General Institution for the Gratuitous Cure of Malignant Diseases - a simple four-storey house in one of the poorest parts of the city - was conceived as a hospital to which the only passport should be poverty and disease and where treatment was provided free of charge to any destitute or sick person who asked for it.





William Marsden
















Royal Free Hospital

The demand for Marsden's free services was overwhelming. By 1844 his dispensary, now called the Royal Free Hospital, was treating 30,000 patients a year. With consultant medical staff giving their services free of charge and money from legacies, donations, subscriptions and fund-raising events, the Royal Free - now re-housed in larger premises - struggled to fulfil Marsden's vision until 1920 when, on the brink of bankruptcy, it was forced to ask patients to pay whatever they could towards their treatment - just like every other voluntary hospital in the country.

Municipal hospitals

As well as the charitable and voluntary hospitals, which tended to deal mainly with serious illnesses, the local authorities of large towns provided municipal hospitals - maternity hospitals, hospitals for infectious diseases like smallpox and tuberculosis, as well as hospitals for the elderly, mentally ill and mentally handicapped.

Mentally ill people

Mentally ill and mentally handicapped people were locked away in large forbidding institutions, not always for their own benefit but to save other people from embarrassment. Conditions were often so bad that many patients became worse, not better. One of my paternal great grandfathers was admitted to Claybury Hospital, Ilford, Essex in 1951 and died there although he was only suffering from depression when admitted.






Claybury Hospital

- Trust me it doesn't look
any better in colour.









Older people

Older people who were no longer able to look after themselves also fared badly. Many ended their lives in the workhouse - a Victorian institution feared by everyone - where paupers did unpaid work in return for food and shelter. Workhouses changed their names to Public Assistance Institutions in 1929, but their character, and the stigma attached to them, remained.

The Beveridge Report

In 1941 the Churchill led coalition Government ordered a report on how Britain should be rebuilt after World War 2 and William Beveridge was chosen to lead the report .

The Report to the Parliament on Social Insurance and Allied Services was published in 1942. It proposed that all people of working age should pay a weekly national insurance contribution. In return, benefits would be paid to people who were sick, unemployed, retired or widowed.

Beveridge argued that this system would provide a minimum standard of living "below which no one should be allowed to fall". He recommended that the government should find ways of fighting the five 'Giant Evils' of Want, Disease, Ignorance, Squalor and Idleness.

Beveridge appealed to Conservatives and other doubters by arguing that the welfare institutions he proposed would increase the competitiveness of British industry in the post-war period, not only by shifting labour costs like healthcare and pensions away from the private companies and into public spending, but also by producing healthier, wealthier and thus more motivated and productive workers who would also serve as a great source of demand for British goods.

Beveridge saw full employment - which he defined as unemployment of no more than 3% - as the pivot of the social welfare programme he expressed in the Beveridge Report, and Full Employment in a Free Society expressed how this goal might be gained. Behind Beveridge's thinking was the creation of an ideal new society after the war. He believed that the discovery of objective socio-economic laws could solve the problems of society.

Labour Election Victory of 1945

Aneurin Bevan (1897 - 1960) was one of the most important ministers in the 1945-1951 Labour government and he overcame opposition to the establishing of the Welfare State.

Bevan was the son of a miner, born in Tredegar in Wales into a poor working class family, giving him first-hand experience of the problems of poverty and disease. As a trade union leader and Labour Party member, he fought all his life to end inequality through the intervention of the state.

At first there was a great deal of opposition to the concept of a National Health Service. When the British Medical Association (BMA) questioned doctors in January 1948, 88% were opposed to the idea. They were frightened that they would lose their independence and be forced to take orders from the government. Bevan was able to win them round by allaying their fears and listening to their opinions.

Hospital consultants were promised a salary and allowed to treat private patients in National Health Service hospitals. This allowed the consultants to keep a separate private income. By July 1948 90% of doctors had joined the new National Health Service. The NHS took over responsibility for the 1,143 voluntary hospitals and 1545 municipal hospitals in Britain, previously run by Local Authorities and voluntary bodies. Family doctors were provided throughout the country; these became known as General Practitioners, or GPs.

How could the government find the money to pay for it? That problem still exists today.

Acts of Parliament

1946 saw the passing of what are probably the two most important Acts Of Parliament to be passed in the 20th Century - the National Insurance Act and the National Health Service Act. The National Insurance Act was concerned with the funding old-age pensions, sickness and employment benefits and death benfits for all insured women, men and their wives. These two Acts would form the basis for what became known as the Welfare State.


to be continued................................