Susie Duffin, Searchroom Assistant and former Midwife
The National Health Service (NHS) was introduced by Aneurin Bevan, Minister of Health, on the ‘appointed day’ of 5 July 1948. It was born out of the ideal that good health care should be available to all, regardless of wealth. There were three core principles: that it should meet the needs of everyone, that it should be free at the point of delivery and that it should be based on clinical need, not ability to pay.
Hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella organisation to provide services that were free for all at the point of delivery.
Before the National Health Service was created, patients generally either had health insurance or they were required to pay for their health care. Free treatment was sometimes available from Voluntary Hospitals, funded by charitable donations and endowments and run by boards of Governors.
Some local authorities operated hospitals for local ratepayers, a system originating from the Poor Law workhouses, particularly in the case of some specialist hospitals, such as Isolation Hospitals for infectious diseases. The family doctor service was funded by private health insurance schemes, such as provided by Friendly Societies and Trade Unions.
The National Insurance Act (1911) was introduced by David Lloyd George, the Chancellor of the Exchesquer (later to become Prime Minister) whereby a small payment was deducted from weekly wages, with added contributions from employers and the government. In return for these contributions, workmen were entitled to free medical care (plus other benefits). This system of health insurance was one of the foundations of the modern welfare state. However, most women and children were not covered by this scheme. By the time of the Second World War there was already some consensus that National Insurance cover should be extended to include the family of the wage-earner, and it was argued that voluntary and local authority hospitals should be integrated.
An Emergency Hospital Service was established in 1939 in anticipation of expected war casualties. Hospitals were registered and then run centrally, which was the first step to creating a National Hospital/Health Service. After war was declared in September 1939, a national register of UK residents was introduced and National Identity Cards were issued.
Although Identity Cards were abolished in 1952, the identity numbers continued to be used for the National Health Service, ensuring each and every individual had a unique number. Initially, National Insurance contributions were made by the purchase of National Insurance Stamps and these included specific contributions for the National Health Service. The National Health Service Act, 1946, was passed to provide for England and Wales a complete medical service, free of charge at the time it is required, for every citizen.
Not everyone welcomed this new National Health Service. There were critics and sceptics, especially among some eminent and influential Senior Clinicians and members of the Boards of Governors of the Voluntary Hospitals. Conversely, others took more positive views even if not strictly accurate. In the minutes of the last meeting of the Royal West Sussex Hospital Board of Governors, the Chairman of the Board, Mr R I Henty, was recorded to have said: “In many ways he had had an easier chairmanship than his predecessors, for in their day there was no bottomless Government purse upon which one could anticipate drawing”. (WSRO Ref: HC/RW 401A, p45)
Of course this wasn’t the case as acknowledged in the First Annual Report of the Chichester Group Hospital Management Committee in March 1950: “The National Health Service has now been in existence for twenty-one months and has grown up against a background of rising costs and financial stringency”. (WSRO Ref: HCH 2/1/1, p17)
Some of the difficulties experienced early on can still be seen today. As medical knowledge, technologies, and treatments increase, so more can be done for greater numbers of patients – more people are living longer and requiring increasing medical intervention. The NHS is continually evolving and has undergone some major reorganisations over the last 70 years. It remains a much treasured national asset and the core principle of free treatment for all based on need, not on ability to pay, is generally maintained today.
On display in the searchroom and visitor’s tearoom is a selection of images from our archives, relating to the history of the NHS in West Sussex.