The beginning of the NHS

This year, on 5th July, we celebrated the 70th birthday of the NHS. The NHS has been, for a long time now, at the centre of British society, a constant contention point in all general elections and even Brexit and immigration debates. Although the debate today generally revolves around money, and although we generally agree that the concept of universal free treatment for patients is a benefit, the beginning of the NHS was not without scandal itself.

On 5th July 1948, Sylvia Beckingham was the first patient admitted to hospital in Manchester treated on the NHS. The idea of uniting all the country’s hospitals into one state-run structure took shape during the Second World War and immediately after. Back then, Britain had 2,700 hospitals run by charities and councils. The sheer number of casualties during the war put immense stress on the hospitals and, combined with low funding, many hospitals were close to bankruptcy.

In 1945, the new government promised a revolution in healthcare. Aneurin Bevan, the charismatic Minister of Health, stated his ambition to build a new health service based on four principles: free to the point of use, available for everyone, paid for out of general taxation and used responsibly. Whilst today you might agree with his principles, 70 years ago a furious opposition comprising consultants, doctors and political rivals existed. The idea of the service being universal came under scrutiny, also its funding from taxation, rather than insurance. The initial rush of patients in the first months of the NHS was blamed by Bevan on the uncertainty of the service being free for long due to the pressure exacted by its opposition. 

In 1951, the vast expense tied to the NHS brought Bevan’s ministerial career to a premature end. With a new government in place, a committee led by Cambridge academic, Claude Guillebaud, was tasked with looking at different ways to pay for the nation’s health. To the government’s surprise, the committee came back with a report confirming that the NHS was an efficient, cost-effective way of treating healthcare, and so the NHS managed to survive its first perilous years and now reaches its 70th year of activity.

Now and then:

  • Life expectancy
    In 1948 the life expectancy for men was 65.9 and for women 70.3. Now it is 79.5 for men and 83.1 for women.
  • Infant mortality
    When the NHS was founded the figure was 34.5 per 1000 live births. In 2016 the figure for infant mortality is 3.8.
  • Prescriptions
    We are currently prescribing more drugs than ever before. In 1948 there were 225 million prescriptions in the UK; in 2016 we reached 1.3 billion prescriptions.
  • Nurses and doctors
    In 1949 there were 60,997 nurses in England and Wales, in 2017 there were 285,093 only in England. Also, the number of doctors dramatically increased, from 11,735 to 109,960. But what does this mean for the average person? Well, in 1949 there was one nurse per 641 people and one doctor per 3,328. Now the figure is much better – one nurse for every 174 people and one doctor per every 473.
  • Spending
    In 1949 we were spending 3.5% of the GDP on the NHS, totaling at about £400m, while in 2016-2017 we were spending 7.3% of the GDP, £144bn.

As we discussed in our previous blog, “Bismarck and the Beginning of Universal Healthcare”, as in that case for Germany, the initial steps of any nationwide healthcare system were a bit of a stumble, often driven or opposed by political considerations, rather than humanitarian ones. Although it might seem easy for us now to think of the nation’s health as a core state concern, a question that needs to be tackled and considered at the highest levels of government, we have to realise that for most of human history, health was considered a personal matter and only in cases of major epidemics would the state intervene. 

It took us millennia to think of the state as a gathering of people with shared cultural values, then as a piece of land defined by arbitrary lines in the sand drawn since time immemorial, and the same thing can be said about healthcare. It took us a long time to see it as the responsibility of the government to ensure the well-being of the nation.

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