The NHS: Britain's National Health Service, 1948–2020

By Susan Cohen

A beautifully illustrated history of Britain's most revered and valued institution: the NHS.

In March 2020 the UK went into lockdown to help contain the spread of COVID-19 and protect the NHS from one of the greatest threats that it has faced in its 72-year history. Today more than ever, all eyes are on this beloved institution as it continues to innovate and adapt to meet the challenges of providing national healthcare in the modern world.

In this fully illustrated introduction, Dr Susan Cohen traces the history of the NHS from its establishment after the Second World War, through seven decades of changing management and organisation, often in controversial political circumstances, right up to the current COVID-19 crisis. Including personal recollections from healthcare professionals on the frontline, as well as the patients in their care, this important and timely volume offers a comprehensive overview of one of the world's most remarkable healthcare systems.

• Language: English
• Publisher: Bloomsbury Publishing
• Release date: Nov 12, 2020
• ISBN: 9781784424800

Susan Cohen

Susan Cohen is an historian with a wide interest in twentieth-century British social history and refugee studies. She has written and lectured widely on a variety of subjects, and is the author of numerous books for Shire, including The District Nurse, 1960s Britain and The Women's Institute.

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CONTENTS

PUBLIC HEALTH CARE BEFORE THE NHS

A NEW DAWN

1950–70

1970–2000

THE NHS IN THE TWENTY-FIRST CENTURY

FURTHER READING

PLACES TO VISIT

ACKNOWLEDGEMENTS

Front page of pamphlet The New National Health Service, prepared by the Central Office of Information for the Ministry of Health.

PUBLIC HEALTH CARE BEFORE THE NHS

BEFORE THE BIRTH of the National Health Service (NHS) on 5 July 1948, which introduced free universal health care across the United Kingdom, the ability to pay was key to accessing whatever rudimentary medical services were available. It was this inequality that the Minister of Health, Aneurin ‘Nye’ Bevan MP (1897–1960), determined to change for ever with the passing of the NHS Act on 6 November 1946.

It’s hard to pinpoint the precise roots of the NHS, but looking back just over a century, even though the picture of medical care was gloomy, there were significant changes emerging which, individually and collectively, had a positive and enduring impact on the health of the nation, and without which the future system would not have been possible. In the mid-nineteenth century the country had no recognisable health care system; infant and maternal mortality rates were high and life expectancy was low. Industrialisation and urbanisation had driven folk from rural communities into towns and cities seeking work, but here they faced poverty in overcrowded and insanitary living conditions – hotbeds for the epidemics of cholera, smallpox and tuberculosis which swept through swathes of the population.

Medical practice was totally unregulated before the Medical Act was passed in 1858, which established the statutory body, the General Council of Medical Education and Registration of the UK. Their remit included compiling and publishing an annual Medical Register of qualified practitioners, protecting the public from charlatans. But the fact remained that the ability of doctors to treat people was bound by the limits of their medical knowledge, and by a person’s ability to pay. Those unable to pay muddled along, relying on a ramshackle collection of largely unprofessional assistants, including quacks and herbalists, or neighbours and relatives who dished out homemade remedies.

Aneurin Bevan, the Labour politician who as Minister of Health inaugurated the free National Health Service, pictured in his London office studying posters prior to the NHS launch, July 1948.

Nursing care, where it existed, was, at best, basic, administered by women whose status, like Charles Dickens’ Sairey Gamp, was no better than a domestic servant. However, change was on the way, helped by Elizabeth Fry (1780–1845), who influenced the future of nursing as a suitable occupation for educated women, albeit within a religious framework. Some of her nurses worked under Florence Nightingale (1820–1910) during the Crimean War, and saw for themselves the positive impact that her insistence on rigorous hygiene had on patient survival rates. Miss Nightingale’s determination to have all nurses trained in her methods led to the establishment, in 1860, of her pioneering nurses’ training school at St Thomas’s Hospital, London. The impact of the higher standards of hygiene and discipline she introduced in the hospital wards was soon replicated elsewhere, so that hospitals began to be safer places, and in Nightingale’s words would ‘do no harm.’

Nurses still had much to learn if they were to fulfil Nightingale’s vision of the professionally trained nurse, and it was largely thanks to the innovative training system introduced in 1880 by her disciple, Eva Luckes (1854–1919), matron of The London Hospital, that her dream was realised. Meanwhile, another important branch of nursing came under Nightingale’s influence in 1859, when she advised the Liverpool philanthropist and social reformer, William Rathbone VI (1819–1902), on setting up his pioneering home nursing scheme for the sick poor. Qualified nurses were soon being trained for district work at the newly founded Liverpool Training School and Home for Nurses, before being sent out to work in local districts. The system was soon replicated across the country, laying the foundation for the future of professional home nursing