Before the National Health Service (NHS) came into being, Britain’s healthcare – and the health of its people – left much to be desired. Pre-Second World War, infectious diseases including diphtheria and tuberculosis were rife, and infant mortality rates were high. Healthcare was something of a postcode lottery, with those who lived near to institutions like the St London teaching hospital in London most likely receiving a higher standard of care than people whose closest port of call was a cottage hospital with few beds. And, of course, people had to pay for their healthcare: in the 1930s, one doctor’s visit was approximately three shillings and sixpence – an eye-watering cost that even the middle classes struggled with.
Officials had recommended that a free national health service should be introduced in England as early as 1920. However, it wasn’t until 1942 and the release of the Beveridge Report, which set out a system of free healthcare funded by taxes, that it seemed possible such an ambitious project could become a reality.
- Read more about life in Britain before the ‘free’ NHS
When did the NHS begin?
On 6 November 1946 Aneurin ‘Nye’ Bevan, the Minister of Health in Clement Attlee’s Labour government, oversaw the passing of legislation that brought the service into being: the National Health Service Act for England and Wales (there was separate legislation produced for Scotland and Northern Ireland). But, as the country was still economically reeling from the Second World War, the service was not formally founded until 1948.
In the early days, Bevan faced opposition from doctors who were worried that working for the service would limit their independence and hamstring their income. But he eventually persuaded them to join the NHS, later claiming that he had “stuffed their mouths with gold”; he agreed that consultants could keep their private practices and thus retain their financial freedom. On 5 July 1948, the day the NHS officially launched, 85 per cent of doctors had signed up with the service.
Blowing the budget
On that first day, the service took control of 480,000 hospital beds, 125,000 nurses, 5,000 consultants – as well as scores of GPs, opticians, pharmacists, dentists and more. Setting the budget for such a large service had not been an easy undertaking, and it soon became clear that demand far exceeded supply. The budget for optical services, for example, was £3.5 million for the first year – the actual cost came to a staggering £15 million. And dentists were swamped, too, as Britons who had previously avoided getting their teeth seen to – pre-NHS, people who needed dental work had to travel to a teaching hospital and often pay for services – flocked to see dentists in their droves. In the first year alone, 33 million pairs of dentures were given out. Dentists who had formerly seen 15 or 20 patients a day were now treating up to 100.
Although some people were at first reluctant to use the service, often worrying what their neighbours would think of them for taking something for free, others took advantage of the free assistance on offer. For instance, one doctor was flummoxed by a patient’s continual requests for free prescriptions of cotton wool. When he finally asked him what he needed it for, he was stunned to discover the man had been using them to wash his greyhound.
With the budget left in tatters, charges were introduced – the first being for dentures, in the early 1950s. Prescription charges soon followed, initially per prescription before it increased to per item. These charges were later removed by Harold Wilson’s Labour government in February 1965, but they gradually crept back in from 1968 onwards. Many exemptions were put in place, though, and a great deal still exist: in 2016, 89.4 per cent of prescriptions were issued free of charge.
Listen: Susan Cohen discusses the highs and lows of the NHS, from its creation in 1948 to the challenges it faces today, on this episode of the HistoryExtra podcast:
Throughout the service’s history, attitudes towards care – particularly in the case of family planning and mental health – have altered dramatically. Originally family planning was never covered in the service’s remit, but when the contraceptive pill was introduced in the 1960s, this was no longer the case. NHS doctors were able to prescribe the pill from the early 1960s onwards – but there was a catch. Only married women were eligible for these prescriptions, and in most cases, they were given out to older women who wanted to stop having children rather than women who didn’t want children at all. Unmarried women resorted to subterfuge to secure their access to the pill, slipping on wedding rings in the waiting room to convince their doctors they had husbands. Later in the decade such charades became unnecessary, as the pill was available through the Family Planning Association.
Meanwhile, attitudes to LGBT+ patients came to the fore in the eighties, when the AIDS crisis ravaged England. Following actor Rock Hudson’s death from an AIDS-related condition in 1985, UK headlines foretold a plague and stirred up prejudice. The NHS and the department of health were very slow to respond, launching their health campaign about the virus in 1987. With the slogan “Don’t die of ignorance”, the campaign was meant to raise awareness of the disease and hammer home how dangerous it was: a film commissioned for the campaign prominently featured a tombstone. Contact tracers were also sent out into the community to speak with those who had had relations with AIDS sufferers, and a succession of large-scale campaigns about HIV and safe sex followed.
Treating mental health has changed greatly during the service’s history, too. The early NHS inherited a collection of ‘asylums’ that were in a terrible state. In the 1970s, these asylums were closed down and sold off, and the onus for mental health care was moved towards the community and smaller, local hospitals, with varying levels of success. A raft of new drugs were introduced too, to help treat psychosis and depression, and – particularly in recent years – attitudes towards mental health have largely improved.
Vaccinating the nation
The NHS has carried out several high-profile immunisation drives throughout its history – most notably the vaccination campaigns for polio, measles, and of course the current push to vaccinate the country’s population against Covid-19.
Less than a century ago, polio – a debilitating disease that can cause paralysis – was feared across the world. In 1955, a British version of the US vaccine was successfully developed and rolled out across the country. And by 1962, a version of the vaccine that could be administered on a sugar lump was pioneered, which made vaccination even simpler.
However, the public response to the polio vaccination drive was initially rather poor. In the 1950s, epidemics of the disease were breaking out in the Midlands and Northern Ireland. These two spikes in cases helped persuade people to get vaccinated, as well as the surprise death in 1959 of a 29-year-old footballer called Jeff Hall, who had died within a fortnight of being diagnosed with the disease.
Once people were convinced of the need to be vaccinated, the program was rolled out very quickly, and the virus was eventually eradicated in the UK (the last polio outbreak in the country happened in the late 1970s).
But for those who weren’t vaccinated in time and who had to be treated by the NHS for polio, their experiences were often horrible. Children recalling their treatments spoke about being kept in iron lungs (machines to assist with breathing which were akin to large metal coffins), and they were rarely allowed to see their parents. Once they were allowed home, they often had to sleep in cold plaster casts and wear callipers (leg braces).
However, the polio immunisation drive pales in significance when compared to the race to vaccinate the UK’s population against Covid-19 – and treat those who are suffering from its effects. In the words of historian Susan Cohen, “the service has responded absolutely remarkably” to this unprecedented strain on their resources and staff. Cohen says: “They’ve put their lives on the line to save other people, and that’s what the NHS has always been about.”
Dr Susan Cohen is a historian with a special interest in British social history. She was talking to Rhiannon Davies, BBC History Magazine sub editor, on an episode of the HistoryExtra podcast.