Happy 70th Birthday, The National Health Service

Happy 70th Birthday, The National Health Service

This month sees the National Health Service (NHS) celebrate its 70th birthday. We want to help the NHS celebrate and mark the incredible work done by the staff across the service.

‘All it takes to survive is to have folk left with faith to fight for it’

Aneurin Bevan MP

The National Health Service was born on July 5th, 1948, when the then Health Secretary Aneurin Bevan MP (pictured below), also known as Nye, launched the NHS at Park Hospital, Manchester, which is today known as Trafford General Hospital. This official launch of the NHS was the culmination of a hugely ambitious plan to bring healthcare to all.

Aneurin Bevan MP

Who was Aneurin Bevan MP?

Aneurin Bevan was born on 15th November 1897 in Tredegar, Wales, he was the son of a coal miner. He went on to represent Ebbw Vale in South Wales in the House of Commons for the Labour Party for 31 years. During his time in Parliament he held several roles:

Parliamentary Role Position held from Position held until
Minister of Health 3rd August 1945 17th January 1951
Minister of Labour and National Service 17th January 1951 23rd April 1951
Shadow Foreign Secretary 22nd July 1956 4th May 1959
Deputy Party Leader (Labour) 4th May 1959 6th July 1960

Obviously, the role that we will focus on throughout this month’s blog is his role as Minister of Health, where he formed the National Health Service.

Aneurin died on the 6th July 1960 but was named as the number 1 Welsh Hero on a list of 100 voted by members of the public in 2004.

Before the NHS

Prior to the NHS in Britain, healthcare was unevenly distributed across the country. If you were lucky enough to live near a teaching hospital for example St Thomas’ in London you would most probably receive wonderful resources and healthcare, however if you were having to rely on a smaller cottage hospital, you would probably receive a lesser standard in your healthcare. Not only that but, depending on where you lived in the country would depend your access to a General Practitioner (GP). For example, industrialised areas of the country suffered from a lack of doctors and healthcare.

As we know today, the NHS is a service which is free at the point of delivery, before the NHS was established sadly this was not the case. The fee you would have to pay pre-1948 in Britain would vary depending on your occupation, class, gender and age.

The 1911 National Insurance Act had gone some way to assist the fees but wasn’t fully effective. Under the Act working men would usually possess health coverage, which provided access to a ‘panel’ doctor for a contribution from their weekly wage. Sadly however, the working men’s dependants (wives and children) were not covered by this and would have to pay for their healthcare out of their own pockets, typically this would cost 3 shillings and sixpence in the 1930s, about £8.01 in today’s currency! Because of this injustice, women and children faced the harshest barriers to healthcare. Not only this but should a working man earn too much, therefore over a wage limit, he too would be barred from health services under this process and again would have to pay for his own healthcare. National Insurance depended, as we mentioned above, on occupation, and therefore the long-term unemployed struggled to access healthcare as they simply couldn’t afford the healthcare fees.

Interestingly, many people in the country felt affection for the pre-NHS system, many liked the charitable spirit of community hospitals and their place within the community. Many contributed to popular voluntary hospital contributory schemes from their wages to enjoy world-class medical care. Many local authorities ran impressive municipal hospital services, by 1939 London County Council supplied the largest number of municipal beds in the World!

The Birth of the NHS

As the idea of a National Health Service was mooted around it was met by scepticism, because of the affection that many felt in the country for the pre-NHS system. During the Second World War, polls were conducted to find out what the country felt, it was revealed that there was no clear majority for National Healthcare and many worried that they might lose their personal touch in medicine they felt they were receiving should the Government nationalise hospitals.

It is probably worth mentioning at this point that during World War 2 the Labour party entered into a coalition with the Conservative Party, led by Conservative Prime Minister (Sir) Winston Churchill.

This poll represented a problem for the Government, who thought that a state organised Health Service was the correct way forward to address the gaps in the old system and to provide free healthcare for all. On June the 10th 1941, Arthur Greenwood, a Labour MP, announced the creation of an inter-departmental committee which would, carry out a survey of Britain’s social insurance and allied services. Its main aim was:

To undertake, with special reference to the
inter-relation of the schemes, a survey of the
existing national schemes of social insurance
and allied services, including workmen’s
compensation, and to make recommendations.

Its members were civil service members from:

  • Home Office,
  • Ministry of Labour and National Service,
  • Ministry of Pensions,
  • Government Actuary,
  • Ministry of Health,
  • HM Treasury,
  • Reconstruction Secretariat,
  • Board of Customs and Excise,
  • Assistance Board,
  • Department of Health for Scotland,
  • Registry of Friendly Societies, and
  • Office of the Industrial Assurance Commissioner.

The inter-departmental review published a report which was printed by Alabaster Passmore and Sons, which would have been a welcome for the printing factory in Maidstone as there was little other printing to be done. The report made three guiding principles:

  1. Proposals for the future should not be limited by ‘sectional interests’. A ‘revolutionary moment in the world’s history is a time for revolutions, not for patching’.
  2. Social insurance is only one part of a ‘comprehensive policy of social progress’. The five giants on the road to reconstruction were Want, Disease, Ignorance, Squalor and Idleness.
  3. Policies of social security ‘must be achieved by co-operation between the State and the individual’, with the State securing the service and contributions. The State ‘should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family’.

The report is referred to as ‘The Beveridge Report’ after the report author William Beveridge who was a Liberal MP, but the report’s real title is ‘Social Insurance and Allied Service’.

In 1944, the Conservative led coalition introduced the first parliamentary bill for a National Health Service.

In 1945 when the Labour party won the General Election, Prime Minister Clement Atlee tasked Aneurin Bevan with the challenge of acting on the Principles and so the NHS started to be born. Bevan is remembered as the Father of the NHS. Through the early days of his work, Bevan had many disagreements with the British Medical Associations with insults being hurled from both sides.

Obviously, it was not just Bevan that put the foundations into the changing of the system from the old sporadic system to what became the NHS, civil servants like Enid Russell-Smith had a huge part to play in bringing 1,143 voluntary hospitals and 1,545 municipal hospitals totalling 480,000 beds in England and Wales alone into a state-run organisation. Russell-Smith expressed anxieties as to where such numbers of hospitals and beds could come under such a service and whether the country would actually welcome it. She and her civil servants worked tirelessly to ensure that the necessary paperwork and administrative processes were put into place by appointed day, 5th July 1948.

A leaflet produced to introduce the NHS

During the setting up processes, she attended many long meetings along with Bevan with doctors and dentists to negotiate with them and put the notion of the NHS to them and bring them on board. Russell-Smith describes them as ‘bloody-minded’ doctors and ‘revolting’ dentists. During these meetings, she grew frustrated but her admiration of Bevan continued. Russell-Smith says of Bevan that ‘he really is an astonishing creature full of thunder and lightning although he lacks the quality of reasonableness which counts so much in British Life’.

As appointed day, or as we will call it the NHS Birth Day, approached, a public service leaflet was produced and circulated as shown to the right, to introduce the idea of the NHS to the public and reassure the public in some respects that if they were happy with their doctor, they would need to do nothing. As the day drew close, Russell-Smith articulated her sense of concern over the success or otherwise of the NHS. She wrote:

‘We shan’t really know how badly we have
done until about the 6th July when no doubt an
angry mob will be trying to burn down Whitehall’

With the public unsure of the NHS and the people behind it unsure of its reception, it really is a wonder that what we appreciate today as a best loved British institution ever actually came to fruition at all.

Every 24 hours the NHS treats more than 1.4 million patients

The Principles of the NHS

When Aneurin Bevan set up the NHS on July 5th, 1948 he set out 3 core principles which were:

  1. That it meets the needs of everyone.
  2. That it be free at the point of delivery.
  3. That it be based on clinical need and not ability to pay.

These 3 core principles still exist today and have guided the work the NHS has done in its 70 years. Although the NHS has changed over the years, it still holds these core principles at its heart today and long may this continue. In 2011, the Government published the NHS Constitution which has 7 principles which built upon the 3 core principles as follows:

  1. The NHS provides a comprehensive service available for all.
  2. Access to NHS services is based on clinical need, not an individual’s ability to pay.
  3. The NHS aspires to the highest standards of excellence and professionalism.
  4. The NHS aspires to put patients at the heart of everything it does.
  5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.
  6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.
  7. The NHS is accountable to the public, communities and patients that it serves.

In addition to the NHS Principles from the NHS Constitution there is a series of Values the NHS works under as follows:

  • Working together for patients.
  • Respect and dignity.
  • Commitment to quality of care.
  • Compassion.
  • Improving lives.
  • Everyone Counts.

It is fair to say that the NHS was set up as a force for good to ensure that everyone could access healthcare free at the point of delivery regardless of age, gender, employment status and class. If you needed healthcare, you got healthcare, paid for from central Government taxation. 70 years on this is still the cornerstone of the NHS.

1948 compared to today

  1948 2018
Population 50,033,200 65,640,000
Life Expectancy – Men 66 Years 84.4 Years
Life Expectancy – Women 71 Years 87.6 Years
Deaths per 1,000 births 34 3.8
G.P.s 16,864 41,817
Budget £437,000,000
(437 million)
£110,000,000,000
(110 billion)

Prescriptions

When Bevan set up the NHS, he set it up to be entirely free at the point of delivery, this was to include free prescriptions and free glasses. In the NHS Amendment Act 1949 the power to charge was introduced, this was a key factor in the resignation of Aneurin Bevan from the Labour Government in 1951.

The first NHS Prescription to be charged was in 1952.

1948: Free

1952: 1 Shilling (£1.56)

2018: £8.80

How has the NHS changed lives?

Over the last 70 years the NHS has changed the lives of the people of the UK in many ways. Obviously the first way that the NHS has changed lives, is by being able to offer healthcare to everyone, regardless of age, gender and employment status, free at the point of delivery. This has enabled life to go on, and in many cases go on longer than ever before as health needs can be treated.

Although vaccination outdates the NHS, in today’s world a vaccination schedule exists to offer the best care for people in the United Kingdom. In 1958, under the NHS a polio and diptheria vaccinations’ programme was launched, prior to this programme diptheria caused up to 5,000 deaths, due to the vaccinations’ programme a dramatic decrease in both diseases followed!

The NHS, through medical advances and its funding for people to access good quality healthcare free at the point of delivery, has helped to reduce pain that patients suffer and in particularly long-term pain. Operations like hip replacements first took place in 1962 on the NHS, since then they have undertaken around 77,000 hip operations each year. This is something that would never have occurred in the pre-NHS era, as the operation would be too expensive for the patient to pay for and therefore would decide not to undergo the operation and suffer with the pain.

For couples who are unable to have babies, the NHS has been good for them since 1978, when the world’s first test-tube baby was born. In 2016 there were over 68,000 IVF treatment cycles on the NHS resulting in 20,028 births. Since our NHS successfully created the first test-tube baby in 1978 over 5 million babies have been born through assisted reproduction worldwide, an amazing statistic for our world-renowned NHS.

The NHS over the years has worked closely with cancer charities to help identify, diagnose, and treat many different types of cancers. Should the NHS not be around supporting patients and working hard to research cancer with the charities, many more people would die.

Since its foundation, the NHS has provided many people with a second chance, and in some cases helped people to cheat death. I am of course referring to transplants, the NHS carries out a wide range of transplants across its working day, from heart transplants through to hand transplants. That of course is in addition to all the emergency life-saving operations they conduct every day. This cannot be done however without the help of others, the donors. Some people donate their blood, others have signed the donor register and have donated their organs for transplant once their life expires.

For more information on the donor register visit:

https://www.organdonation.nhs.uk/register-your-decision/register-your-details/

What challenges lie ahead for the NHS?

Many challenges lie ahead of the NHS, not just in the next 30 years in the run up to the centenary of this amazing, extraordinary institution, but beyond that through the next 70 years, but of course there are more pressing challenges in the immediate years ahead.

Rightly, the public has a high expectation of the quality and performance of the NHS, but of course the general public can help take the pressures off the NHS by thinking about what service they actually require before calling for an ambulance or presenting at the A&E departments which are already pushed to the limits.

Let’s consider the challenges that lie ahead for this amazing public service:

Ageing Society

Studies suggest that the majority of health expenditure is from older patients, that of course doesn’t bode well when the nation is living longer and longer. However, it is good news that we are living longer. Studies show however that nearly two thirds of people who are admitted to hospital are over 64 years old. When they are admitted to hospital, typically 2 million people every year, they stay longer and then are more likely to be readmitted to hospital.

In the coming decades all research suggests that the healthcare needs for the ageing society is likely to grow markedly, it is most likely to be in the number of 85 or over age range who are the most intensive users of health and social care.

Rise of long-term conditions

People who have one or more long-term conditions are already the most important source of demand for the NHS services. Some reports suggest that the 30% of people who have one or more long-term conditions, accounting for £7 out of every £10 spent on health and care in England, fall into this bracket.

Other reports suggest that one long-term illness is more expensive for the NHS than those with three of more conditions, the financial comparison suggests one long-term illness costs the NHS £3,000 per year whereas those with 3 or more long-term illnesses cost nearly £8,000 per year.

The NHS says that multiple long-term conditions must be managed differently, their remark being that a hospital-centred delivery system made sense in the 20th Century for the diseases that were being faced then but going forward, patients could be managing their own care at home, supported by technology and supported by a range of professionals.

Lifestyle risk factors in the young

It is commonly understood that personal circumstances greatly increase the risk of developing debilitating diseases. Risk factors have been examined over many years, with the NHS quoting unhealthy behaviours such as:

  • Drinking,
  • Smoking,
  • Poor Diet, and
  • Lack of exercise.

Should the studies and predictions be correct 46% of men and 40% of women will be obese by 2035, this is likely to result in 550,000 additional cases of diabetes and 400,000 additional stroke and heart disease cases. This going forward is likely to add further financial challenges for the NHS.

Increasing Expectations

In their own words, NHS England says that patients and the public have high expectations for the standards of care in the NHS. Patients are increasingly demanding access to the latest therapies, more information and more involvement in decisions about their care.

Patients want a 7-day access to primary care provided to them near to their homes, place of work or even their local shop or pharmacy. They also want a co-ordinated health and social care service tailored to their own needs; this going forward for the NHS will need them to carefully rethink where and how they provide the services the public seems to want.

I do wonder however, how the public requirements would have worked under the old system, and in reflection it goes to show that the NHS is a victim of its own success.

Increasing costs of providing care

It is no secret that the cost of providing care is getting more and more expensive, but at the same time, the NHS now offers a much more extensive and sophisticated range of treatments and procedures that in fairness Aneurin Bevan could never have envisaged when he founded the NHS.

The NHS is now able to treat conditions that would have potentially gone undiagnosed, or simply untreated, it has access to new drugs, technologies, and therapies that make a major contribution to curing diseases and extending the length of life.

It goes without saying that these are good things and that the NHS is doing a wonderful job, but the cost of new technologies is more expensive than what they are replacing.

Going forward the NHS managers are going to have to ensure that they invest in technology and drugs that demonstrate the best value for money and that will make a difference to the people they are designed to care for.  

Constrained public resources

The sad thing for the NHS and other public-funded services is that they are facing fresh new challenges like the ones we have discussed above at the same time as the country is facing one of the most serious economic crises since the 1930s, again something the NHS founder Aneurin Bevan couldn’t have envisaged.

The Government has ring fenced the NHS budget to try to at least keep the budget where it is or at the least to increase with the overall GDP growth; this presents the managers with a challenge to ensure they can meet the continuing needs of the public. It is true to say however that just a few weeks ago, the Prime Minister Theresa May has pledged an extra £20 billion for the NHS going forward into 2023.

The NHS is a great institution and one that is respected around the world. I would like to thank it for everything it has done for my family and myself over the years, hope it enjoys its 70th birthday celebrations and may it live long into the future with the 3 core principles that Aneurin Bevan founded it on in 1948. In summary, to remind you these are:

  1. That it meets the needs of everyone.
  2. That it be free at the point of delivery.
  3. That it be based on clinical need and not ability to pay.

Happy 70th Birthday NHS

Thank you to all the
great GPs, Nurses, Doctors, Paramedics
for all you have done for my family and me over the years.

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