50th anniversary infographic
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NHS

NHS reaches its 50th birthday

July 5, 1998 - The British NHS celebrates its 50th anniversary of providing health care to all. Graphic shows key events in the history of Britain's National Health Service.

The Beveridge Report of 1942, which proposed the establishment of a National Health Service, stood in a long line of calls for the state to provide comprehensive medical care. They began, in 1909, with Beatrice Webb’s submission to the Royal Commission on the Poor Law, but it was not until 1946, following the election of a Labour government, that the White Paper ‘A National Health Service’ was published. Two years after that the NHS Bill was law. Aneurin Bevan, the Health Secretary who had been midwife to the service’s birth, presided over the official opening ceremony on July 5, 1948.

The NHS was instantly, inevitably, hugely popular. Ninety-five percent of the population – poorly served by cash-strapped voluntary organisations and the loathed municipal hospitals – opted to use its services, particularly the 2,751 newly-nationalised hospitals. Demand quickly outstripped supply, and Bevan resigned in 1951 when nominal prescription charges were introduced to cover costs.

Triumphs followed: the first successful internal heart surgery was undertaken in 1948, while 1968 heralded a groundbreaking successful heart transplant. By 1979, tuberculosis – which had been responsible for 16 percent of all British deaths in the mid-19th century – killed only 0.1 percent.

But strain on the service soon began to tell. Proliferating specialisms and an ageing population drove costs higher, while industrial action from the left and hostility from the right diverted funds and energy from the service’s original aims. By the time Margaret Thatcher’s Conservative government published the 1988 White Paper ‘Working For Patients’, the need for change was clear. Whether the changes to which it led were desirable ones was far less so.

By 1991 an internal market had been introduced, designating sectors of the NHS either as purchasers of services or as providers charged with bidding for contracts. The vagaries of this system – combined with the fact that it was only partially implemented – led quickly to accusations of two-tier care delivery. Further upheavals seemed inevitable.

The latest changes began with the election of the Labour government in May 1997. Labour – its health policy co-ordinated by Secretary of State Frank Dobson – is committed to abolishing the internal market while maintaining those elements of the new NHS which work. Exactly how this will be done remains unclear. But a report just published, jointly by the British Medical Association, the Royal College of Physicians and the Royal College of Surgeons, suggests what may be to come. They envisage giant regional ‘super-hospitals’, serving populations of up to half a million – combatting the escalating cost of care with economies of scale. It is all a very long way from Nye Bevan’s dream – but also, mercifully for the NHS’s many supporters, just as far from healthcare systems like America’s, where the only guarantee of medical treatment is still, in most cases, expensive private insurance.

PUBLISHED: 30/6/1998; STORY: Oliver Burkeman
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