National Health Service

National Health Service. Established in 1948, the NHS grew out of the Second World War's reconstruction planning of social and medical services, after long debate over health-care provision (Dawson Report, 1920; Cathcart Report, 1936; Sankey Commission, 1937). The 1942 Beveridge Report assumed that a satisfactory social security scheme depended on ‘comprehensive health and rehabilitation services for prevention and cure of disease and restoration of the capacity to work’, available to all the community. The subsequent deadlock arising from self-interested opposition was broken by Aneurin Bevan, who established a tripartite administration: local authorities (for existing clinics and new health centres), panel practice, and nationalized hospitals (conceding some private practice for consultants, and giving teaching hospitals special status). Since the new service was entirely free to patients, funding had to come from taxation, but Beveridge's view that costs would lessen as the nation's health slowly improved had not allowed for the massive backlog of unmet need nor for technological advances such as joint replacements. The introduction of charges for prescriptions, dental, and ophthalmic treatment (1951) led to Bevan's resignation on grounds of principle. Accusations of extravagance proved unfounded (Guillebaud Report, 1956), and hospital-building, application of medical advances, and staff expansion continued to be sustained by economic growth. Under the aims of improved management and services, the 1960s saw recommendations for the abolition of tripartite administration (new structure implemented 1974), with such reorganization being associated with more professional management. But implementation of policies formulated in a more confident economic climate led to increasing criticism of the use of business theory to solve the NHS's financial problems. Total spending continued to rise. As resources were shifted away from patient care into administration, justifications for internal markets to produce savings were unconvincing to many commentators; economies from ward/hospital closures or sale of assets seemed illusory, while the morale of many NHS employees plummeted. The opting-out of newly formed hospital trusts from local health board control and introduction of fund-holding for general practitioners threatened to recreate earlier inequality and fragmentation, despite the perceived need for better community and preventive medicine. Centralized bureaucracy, changing needs of patients, and serious under-funding have contributed to a now crumbling structure, with significant shortage of trained staff. Governmental reviews continue to promise reform, but public scepticism persists.

A. S. Hargreaves/ and Professor J. A. Cannon