History of the National Health Service (England) facts for kids
The National Health Service (NHS) in England was created by a law in 1946. It officially started in 1948. The NHS aims to provide healthcare for everyone, free of charge at the point of use. In 1969, the responsibility for the NHS in Wales was given to the Secretary of State for Wales, meaning the Secretary of State for Social Services then focused only on the NHS in England.
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How the NHS Started (1948–1969)
When the NHS first began in England and Wales, it had three main parts, sometimes called the tripartite system:
- Hospital services: Large hospitals were managed by regional boards. Smaller hospitals were run by local committees. Teaching hospitals, which are linked to universities, had their own special boards.
- Primary care: This included GPs (family doctors), dentists, opticians, and pharmacists. They worked as independent businesses, not directly employed by the NHS. Councils were set up to manage their contracts and payments.
- Community services: Local councils were in charge of services like maternity and child health clinics, health visitors, midwives, health education, vaccinations, and ambulance services.
In 1948, the NHS became one of Britain's biggest employers. It had about 364,000 staff across England and Wales. This included thousands of doctors, nurses, midwives, and many other important staff.
Early Challenges and Changes
By the early 1950s, the NHS was spending more money than expected. Because of this, small charges were introduced in 1952. For example, there was a small fee for prescriptions and for dental treatment. These were some of the few exceptions to the NHS being free.
In the 1950s, there was a lot of planning to make sure hospital services were spread out well and avoided overlaps. The number of medical staff also grew. By 1956, the NHS faced money problems, and doctors were unhappy with their pay. A special group was set up to look into doctors' wages. The Mental Health Act 1959 also changed laws about mental illness, making it harder to keep someone in a mental hospital against their will.
Growth and New Treatments in the 1960s
The 1960s were a time of growth for the NHS. Prescription charges were removed in 1965 but brought back in 1968. Many new and important medicines and treatments became available. These included the polio vaccine, dialysis for serious kidney failure, and chemotherapy for some cancers. While these treatments improved health, they also added to the NHS's costs.
Health Secretary Enoch Powell introduced some big plans:
- The Hospital Plan (1962): This plan suggested building new district general hospitals to serve areas with about 125,000 people. It set out a clear plan for hospitals across the country.
- Mental Health Institutions: Powell also predicted that many large mental health hospitals would close within ten years, moving care closer to people's homes.
Concerns continued about how the NHS was structured. A new agreement called the Charter of General Practice gave doctors financial help to improve their practices. This encouraged doctors to work together in larger groups, leading to the modern idea of primary health care centres.
In 1969, the responsibility for the NHS in Wales was officially moved from the UK Health Secretary to the Secretary of State for Wales. This meant the Health Secretary was then only responsible for the NHS in England.
The 1970s and Early 1980s
The NHS in England was reorganized in 1974. This change brought together hospital services and local council health services under new regional health authorities. There was another reorganization in 1982.
The 1970s also saw an end to the strong economic growth of the 1960s. This led to more pressure to spend less money on public services and to make sure the money spent was used as efficiently as possible. During this period, there were also very serious issues with some medical treatments involving blood and blood products.
Thatcher Government Changes
In the 1980s, the government led by Prime Minister Margaret Thatcher brought in many changes to how the country was run. While many public services saw big changes, the National Health Service remained very popular and had strong support, even within the Conservative Party. Margaret Thatcher famously said in 1982 that the NHS was "safe in our hands."
Modern Management and the "Internal Market"
In the 1980s, new management ideas were brought into the NHS. The Griffiths Report in 1983 suggested appointing general managers to be clearly responsible for different parts of the NHS. It also recommended that doctors should be more involved in managing services.
Money problems continued to put pressure on the NHS. In 1988, Margaret Thatcher announced a review of the NHS. This led to two important documents in 1989 that introduced something called the "internal market." This new system changed how health services were organized for much of the next decade. Even though many doctors were against it, the internal market was put in place.
The National Health Service and Community Care Act 1990 officially created this "internal market" in England. Under this system, health authorities no longer ran hospitals directly. Instead, they "bought" care from hospitals, which became independent NHS trusts. Some GPs also became "fund holders," meaning they could buy care for their patients directly. This system aimed to encourage competition, but it also led to more differences in services between local areas. Studies suggest that while this competition might have led to shorter waiting times, it sometimes reduced the quality of care.
Blair Government Reforms
The Labour Party, led by Tony Blair, came to power in 1997. They had promised to get rid of the "internal market" and the "fund holder" system. Tony Blair said that the new plan would replace the internal market with "integrated care," putting doctors and nurses in charge. He believed this would save money and improve patient care by setting national standards.
However, during his second term, Tony Blair's government actually brought back some parts of the internal market. These reforms were driven by several factors, including the rising costs of new medical technology and medicines, the desire to improve standards and give patients more choice, and the fact that the population was getting older. Since the health services in Wales, Scotland, and Northern Ireland are managed separately, these reforms led to more differences between the NHS in different parts of the UK.
Key Changes and Challenges
The reforms included setting detailed standards for services, strict financial rules, and new job descriptions. A new version of fundholding, called "practice-based commissioning," was introduced. New services like NHS Direct were developed to help manage demand. There was also a new focus on staff changes, with the Agenda for Change agreement aiming to make pay and career paths fairer. These changes sometimes caused debate among medical professionals and the public.
The Blair Government also encouraged private companies to provide some medical and support services, while keeping services free for patients. Under the Private Finance Initiative, many new hospitals were built by private companies. These hospitals might have both medical services (like special surgery centres) and non-medical services (like catering) provided by private companies. Studies showed that these privately financed hospitals often had fewer beds than the older hospitals they replaced.
The NHS also faced big problems with new information technology (IT) systems during these reforms. The National Programme for IT (NPfIT) was a huge project to computerize all NHS patient records. It ran far behind schedule and cost much more than planned. There were also concerns about keeping patient information safe and about doctors finding the new systems difficult to use.
Despite these challenges, between 2004 and 2014, the NHS provided many more services. Hospital admissions, outpatient visits, and GP consultations all increased significantly. Hospital death rates also went down, especially for conditions like stroke. Overall, the NHS became more productive during this time.
Coalition and Cameron Government Reforms
When a Conservative-led government returned to power in 2010, there were more disagreements with NHS staff. The Health and Social Care Act 2012 brought in more private sector involvement. This led to large protests by health workers. Some NHS staff also went on strike in 2014 over pay. In 2016, junior doctors also took major strike action to protest a new contract that aimed to extend weekend working hours. The 2012 Act didn't increase patient choice as much as planned, but it did mean more of the NHS budget went to private healthcare providers.
In 2019, doctors and politicians raised concerns that the ongoing use of private companies for some NHS England cancer screening services could harm patients. In July 2019, it was announced that the NHS would work with the virtual assistant Amazon Alexa to provide health advice directly from the NHS website.
See also
- History of the National Health Service
- History of NHS Scotland
- History of NHS Wales
- History of Health and Social Care in Northern Ireland
- Keep Our NHS Public
- List of hospitals in England
- List of NHS trusts
