Earlier this year I set out to understand more about the history of the National Health Service. As well as reading some books recommended by colleagues, I’ve picked up a few original 1948 documents from online auctions. Some archaic language aside, they’re as fresh and relevant today as they were 70 years ago.
Exhibit 1: a variant of the wonderfully clear and concise leaflet sent to every household to explain the new service. The version I have was for service men and women, a reminder of the NHS’s roots in, and proximity to, the horrors and the heroic national collaboration of the Second World War.
As a value proposition, the introduction to this leaflet is hard to beat:
It will provide you with all medical, dental, and nursing care. Everyone — rich or poor man, woman or child — can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.
- Comprehensive coverage – medical, dental and nursing
- For everyone – rich and poor alike
- Coverage of women and children equally with men (pre-World War II, many men were in work-based insurance schemes, but their wives and children had no such coverage)
- Emphatically not a “charity”, but rather a collective endeavour by us all
- It will relieve your money worries – because the stress of illness can only be compounded by financial hardship.
Every recipient of the leaflet also had a thing to do: “Choose Your Doctor Now”. Despite the scale of this national undertaking, the NHS took flight on the wings of millions of individual choices – people registering themselves and their loved ones with a family doctor. (Whether those GPs would take part at all was a close-run thing demanding give and take from Nye Bevan on one side and the GPs’ leaders on the other.)
Exhibit 2: fast forward a few months to this booklet, published by the Ministry of Health (loving that logo) soon after the NHS’s creation.
A thicker, more reflective read than the first leaflet, this one was produced not long after the foundation, when most people had chosen a doctor, but the new system was just finding its feet. The first of many attempts to show who does what…
Compare with this 2017 version from the King’s Fund…
The final, and most forward-looking, chapter of the second booklet is my favourite.
THIS BOOKLET has tried to explain the reasons for the new deal in medical care, and the organisation created for it by the Act. It has described what the medical services look like in the beginning, soon after the Act is in force. What will they look like in ten years’ time? The Act is only the means of getting the new deal started. In what direction will the new partnership of the professions and the ‘consumers’ work to carry out their purpose of meeting the medical needs of the people adequately, everywhere?
See how the new partnership comes with scare quotes around the word ‘consumers’? Perhaps the authors hoped we’d find a better noun some time in the next decades. We’re still working on that.
The “six main aims” bear repeating – all having been reprised many times in the last 70 years…
(1) Up-to-date material resources. A large programme is needed as soon as it becomes practicable, for rebuilding and re-equipping hospitals and clinics and for constructing health centres.
(2) Adequate human resources. More health workers of most kinds will have to be trained as soon as possible.
(3) Better distribution of resources. The aim must be to bring more of the services to the places where the patient can conveniently use them.
(4) Greater team work in serving the patient. This is necessary among family doctors, within the hospital service, and between all the services, to avoid the departmentalising of medicine which prevents doctors from seeing the patient as a ‘whole person’ rather than as a ‘case’.
(5) Encouragement of variety and experiment. Medical needs must be adequately met everywhere, but it would be wrong for them to be met everywhere in the same way. Medicine thrives on experiment and comparison of different ways of doing things; uniformity of method or belief is its enemy.
(6) Encouragement of a preventive and ‘positive’ outlook on health. All agree that the nation will not be using its doctors to the best advantage so long as they are confined so much to healing and have so little time for preventing illness.
In places the language of this booklet is breathtakingly modern. I had to do a Google Books search to confirm that the phrase “whole person” was indeed contemporaneous. Also note…
- The emphasis on adequacy as an ambitious but attainable goal
- The need to bring services closer to where people are
- Team work across departments and parts of the service
- My favourite: variety and experiment! “uniformity of method or belief is its enemy.”
- The first of many pleas to prioritise wellbeing and prevention of illness
There’s a sober assessment of the nascent service’s chances. Transformation takes time, costs money and is inherently uncertain…
In the hospital and specialist services the pursuit of these aims will take time. There are still too many awkward and out-of-date buildings; even the existing accommodation cannot be fully used for want of nurses and domestic workers. There are too few of many kinds of specialists, and the few there are are not always well distributed in different parts of the country. The work of the specialist has to be carried beyond the hospital doors more than in the past.
Nevertheless, the Service must be run with proper regard for economy, and capital expenditure has to be kept down to a minimum. Only the most urgent schemes for the extension or repair of hospitals can be permitted. Nor is the building of comprehensive health centres possible on any scale while so great a part of our building resources has to be locked up in urgently needed houses, factories and schools. More study is also needed of the kinds of centres most worth trying out before any large-scale experiments are launched. The building and testing of health centres in action, in different forms and circumstances, in large towns and small, in suburbs and country areas, is a task for the next few years. During that time a great many, perhaps most, family doctors will continue to practise outside health centres, though various looser forms of ‘grouped’ practice and other means of improving the efficiency of the family doctor without comprehensive health centres may prove valuable especially in country districts.
For the time being the main thing is to get the Service into good running order and to keep on improving its efficiency. All big social changes start with a certain amount of uncertainty, until people get used to the new way of doing things; and this Service cannot be comprehensive in the fullest sense until the country is farther along the road to prosperity and a rising standard of life.
Implicit trust in the public as active participants, on whose wise decisions success depended…
The public has still to learn how to use the new facilities properly and economically; and those who are actually running the Service have to get used to new conditions and changing needs. But if the various professions really join forces with the laymen in the organisation described in this booklet, they can carry out a progressive new deal in medical care which will redound to the benefit of all.
A look back, as well as forwards…
The National Health Service represents the completion of the work which was started just over a hundred years ago with the first Public Health Act. Then the emphasis was on environmental conditions — pure water and proper sewerage.
Finally a chance and challenge that stands to this day…
Now the National Health Service brings together the personal services. It offers a chance — and a challenge — to build the most efficient health service in the world, and one which as the years go by will add steadily to the nation’s fitness, happiness and working capacity.
Both documents were subject to Crown Copyright for 50 years, so are now in the public domain. I have scanned and shared them on Wikimedia Commons:
Bonus feature: Halas & Batchelor’s lovely 1948 animation for the Central Office of Information…
Your very good health!
Matt Edgar writes here 