The NHS

The creation of the NHS

• intense negotiation with BMA and managers of local authority , private and voluntary hospitals

• negotionations 1942-44 resolved many of the major issues

• by 1945 - political consensus on state provided , centrally funded healthcare

the national health services act

• centrally organised through ministry of health but run along regional lines

• comprehensive - curative and preventative care , mental and psychical

• free - paid by direct taxation

• all hospitals to merge into one unified system

what initial problems were faced by the labour governmenmt when they intro

• feb-july , 1948 bevan negotiated with BMA - 40% of the BMA voted against working with nhs in feb

• 5th july - 90% of doctors jiined the NHS a month before the launch date ‘stuffing their mouths with gold’

• granted dockts a fee for each patient 

• allowing consulrants to retain private patients

• GP were self employed

privledged groups ran the NHS from the outset 

key early NHS stats 

• by 1949 , 95% of the population were enrolled in the NHS , 88% of doctors had joined

• in the NHS first year , GP  wrote 187k prescriptions

• 8.5 million dental patients were treated , all free prescriptions

why was the NHS more expensive than its founders had expected 

• ‘dandruff system’

• NHS costs soared upwards from £228m to £387m and mant hoapitals needed modernising

• ongoing debate over NHS funding resulted in Bevan resigning in April 1951 over introduction of prescritiption charged by Labour chancellor

How did the NHS develio

• not equal provision across the country 

• inherited existing infrastructure

• 1962 hospital plan act  - 500m investment - 50% reduction in hospital beds for people with mental illnesses

• Charges introduced in 1951, abolished in 1965, then reintroduced in 1969

• NHS reorganisation act - major NHS reform - 

what succeses did it enjoy and what challenges did it dace 

• The NHS allowed many Britons to take advantage of global improvements in combating disease through research, new techniques, vaccination and medicine

• reduction in all categories of disease, but not those linked with old age

• facilitated medical advances - life-threatening illnesses such as cancer and heart disease had much higher recovery rates

• Infant mortality and postnatal complications significantly decreased

• Average infant mortality rates declined, from around 30 per 1000 in 1950 to 10 per 1000in 1980 to 3.8 per 1000 in 2016

The challenges of medical advances by 1979

NHS – “Victim of its Own Success”

• Rising demand: Better services → higher public expectations and usage.

• Medical advances: Expansion of treatments, vaccines, and technology greatly increased provision.

• Rising costs:
  

  • 1950: 4.1% of GNP

  • 1970: 4.8% of GNP

  • 1990: 14% of GNP

• Strain on resources: Demand grew faster than NHS capacity/funding.

• Comparisons: UK govt. spent less on health than other European countries.

• Challenges: Ageing population with complex, long-term health needs.

Expansion of treatments

Prescriptions, drugs, vaccinations, high-tech medical equipment

Treatment and staffing

An ageing population

The NHS performed 24,000 hip replacements in 1979 (first carried out in 1962)

Major surgery

Organ surgery, kidney transplants, heart transplant.

Contraception and abortio

Was an improvement in the health of the nation in the years

1948-79 the main consequence of the creation of the National

Health Service?

Health Improvements

• Wider range of treatments: prescriptions, drugs, vaccines.

• Better access to healthcare for all.

• Life expectancy increased.

2. Rising Costs & Pressures

• Growing expense of prescription drugs.

• Staffing shortages and costs.

• Ageing population → more complex and long-term care needs.

3. Medical & Technological Advances

• Major surgeries: organ transplants, kidney, heart, hip replacements.

• High-tech equipment: CT scanners, new diagnostic tools.

4. Social Consequences

• Contraceptive pill introduced → family planning and reproductive choice.

• Legalisation and provision of abortion under NHS → social and cultural impact.

How significant were the challenges facing

the NHS?

Infrastructure (1948–1960s):

• Little investment in modernising hospitals after 1948.

Spending in 1960s–70s:

• Actual NHS spending higher than predicted → driven by rising demand + past underfunding.

• Govt. responses partly successful but pressures remained.

Pressures on NHS:

• New treatments, rising public expectations, and higher costs increased demand on resources.

Impact of Economic Crises (1970s):

• Limited ability to raise NHS funding.

• Consideration of alternative funding/provision methods.

Main Challenges (1970s):

• Growing demand for services.

• Persistent health inequalities.

• Economic crises restricting funding.

• Long-term concerns about sustainability of NHS funding.

was an improvement in the health of the nation in the years 1948-79 the main concequence of the creation of the NHS , what else

Was an Improvement in Health the Main Consequence of the NHS (1948–79)?

Yes – Health Improved

• Major fall in deaths from diseases like tuberculosis (esp. first decade).

• Poor-quality hospitals closed; new district hospitals + centres of excellence raised care standards.

• Maternal mortality declined; life expectancy rose.

• Access to medical advances (e.g. organ transplants, CT scans).

No – Other Consequences Equally / More Significant

• NHS focused on curing illness (hospital-based care) rather than promoting preventative public health.

• Longer lives → demand for treatment of age-related illnesses (arthritis, cancer, heart disease).

• Costs spiralled: NHS spending rose from <3% GDP (1951) → ~5% GDP (late 1970s).

• Politicisation: Bevan’s resignation (1951), tensions in party consensus, NHS became central to politics.

• Pay for GPs, consultants, and nurses improved under NHS → professional consequences.