the NHS- Britain 1931-52

The Report was greeted with great enthusiasm by the Labour Party

Winston Churchill, the leader of the Conservatives was more sceptical.

Many of its recommendations became the foundations for the Labour measures of 1945-51

The main parts of the Welfare State, the National Insurance Act, the National Health Service Act, the Industrial Injuries Act and the National Assistance Act, were all passed in 1946.

The Acts came into operation in 1948.

Because the Welfare State would require a great deal of planning, a day was fixed for the start of the new system.

This became known as the ‘Appointed Day’, 5 July 1948.

Aneuran Bevan, the Minister of Health, was responsible for improving the nation’s health

In 1946 he introduced the National Health Act

Bevan’s NHS Bill contained four proposals that had not been included before:

• Firstly, all hospitals would be taken over and put under thirteen regional health boards. These in turn would be controlled by the Ministry of Health.

• Secondly, all doctors would be paid a salary, instead of receiving fees for each of their patients.

• Thirdly, doctors would not be allowed to set up new practices in areas where there were already enough doctors. Instead they would be encouraged to move to areas where there were insufficient doctors.

• Lastly, doctors would not be allowed to buy and sell practices and with them lists of patients.

The BMA (British Medical Association), which represented 51,000 GPs and hospital doctors, threatened to boycott the NHS if Bevan’s plans went through unchanged.

The BMA set up a campaign to fight the NHS Bill. It was led by two doctors, Guy Dain and Charles Hill.

Charles Hill was well known as the ‘Radio Doctor’. He had made many broadcasts answering questions on the BBC. Hill was also used by the Conservative Party in its campaign against the NHS.

One letter to the BMJ in 1946 show how strongly many doctors felt:

'The Bill can be written in two lines: I hereby take whatever powers to do whatever I like about the medical services of the country – signed Nye Bevan, Führer'

Bevan, a left-winger in the Labour Party, was likened to Adolf Hitler because of the way he was attempting to enforce changes without consultation.

Bevan’s response was to take a more moderate line.

He knew that without the support of doctors the NHS would not work and so attempted to undermine the opposition by compromises.

He started with the Royal Colleges of Surgeons, Physicians and Obstetricians.

These bodies represented the consultants, most important figures in the medical professions.

Bevan made two important concessions:

• Consultants would be able to work part-time for the NHS and so continue with their private patients.

• They would also be able to use private beds in NHS hospitals to treat their private patients.

These concessions won over the consultants

Bevan was still faced with the opposition of the BMA and its 51,000 members.

In 1947 a poll organised by the BMA showed that 40,814 doctors were against joining the NHS, while only 4,735 were in favour.

Somehow or other, Bevan had to overcome that majority by the ‘Appointed Day’.

Firstly, he agreed that doctors would not be paid solely by a salary; they would also receive a fee for every patient on their list.

Bevan also agreed that doctors who joined the NHS would be able to retain private patients and the fees that they received for treating them.

He did not, however, compromise on the right of doctors to sell their practices. Instead he set up a compensation fund, which provided them with a cash sum when they retired.

Finally Bevan also began a publicity campaign amend it soon became obvious that the British public was giving overwhelming support to the NHS.

If Doctors refused to join, they could lose large numbers of patients to doctors who had joined. 

From the Appointed day, everyone in Britain was entitled to completely free medical care

This included visits to doctors, prescriptions, hospital treatment and operations, emergency services, dental treatment and false teeth, opticians and free spectacles and vaccinations and clinics

All the hospitals in the country (about 3,000) were taken over by the government and doctors were paid by the state.

General Practitioners (GPs) were paid a fee for every patient that they had, no matter how many visits he or she made to the surgery.

Suddenly people’s lives began to change. They could now go to the doctor whenever they were ill without worrying about having to pay.

It made a huge difference to their lives. In 1948 there was a big rush for these services for the first time. Many people had put off going for treatment because of the cost.

In October 1949, the Minister for Health, Aneurin Bevan announced what had happened since July 1948:187,000,000 prescriptions had been provided; 5,250,000 pairs of glasses had been prescribed and 8,500,000 people had been treated at dentists 
 
 The first charges to be introduced were for dental and optical treatment in 1951. These had proved to be the most costly items in the NHS budget. Nye Bevan resigned in protest. 
 

‘the Welfare State was an enormous sigh of relief’. The impact on serious diseases was also dramatic. By 1961, cases of diphtheria had almost disappeared and cases of tuberculosis had fallen by two-thirds. 

 
There were other criticisms of the NHS. One the one hand some said it encouraged people who wanted something for nothing and that taxpayers’ money was being needlessly squandered. Some disliked the fact that there was still private practice. This would lead to twin standards – better care for those that could afford to pay.