From cradle to grave

Aneurin Bevan faced opposition from the medical profession

The National Health Service (NHS) was established as a result of the 1944 White Paper, A National Health Service.

It set out the two guiding principles. Firstly, that such a service should be comprehensive, with all citizens receiving all the advice, treatment and care they needed, combined with the best medical and other facilities available. Secondly, that the service should be free to the public at the point of use.

The National Health Service Act (1946) covered England and Wales - with separate legislation produced for Scotland and Northern Ireland by the Scottish and Northern Ireland offices.

Initially, there was some fierce opposition, including threats of non-cooperation from the British Medical Association (BMA) over issues of responsibilities and pay. But Aneurin Bevan, the Secretary of State for Health, pressed ahead and the NHS was introduced on July 5 1948.

Major change

The Act took into national public ownership the 1,771 English and Welsh local authority hospitals and the 1,334 voluntary hospitals. The overall administration of the system was the responsibility of a health minister through regional hospital boards. General medical and dental services were directed through executive councils, with other health services catered for by county and county borough councils.

As a result, from 1948, the NHS provided a wide range of medical services to the public, including: hospital and specialist services, general practitioner (medical, dental, ophthalmic and pharmaceutical) services, ambulance services and community health services.

Access to these was to be free of charge for UK residents, unless a statute declared otherwise.

Immediate success

The NHS was seen as the high point of the post-war Labour Administration (1945-51) and its appeal was illustrated by the fact that 97% of the public registered with General Practitioners.

However, the financing of the NHS through taxation, with Parliament voting on money to cover costs, proved to be an immediate problem. Initially, and mistakenly, it was predicted that demand would decline as illnesses were cured. In fact, the opposite happened. An ageing population and expensive new technology and drugs created new financial pressures. The perception of the service as 'free' probably exacerbated demand still further.

The difficulties raised doubts about the ability of the state to manage such a centralised and complex service. Nonetheless, despite its flaws the fundamental structure established in 1948, although modified by various Acts, remained largely unaltered until the 1980s.