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During the height of the Second World War when the outcome remained very uncertain the coalition government had already started planning for post war reconstruc

History of the NHS

Wartime Britain

During the height of the Second World War when the outcome remained very uncertain the coalition government had already started planning for post war reconstruction. A national health service was one of the fundamental assumptions in the Beveridge Report which Arthur Greenwood, Labour's Deputy Leader and wartime Cabinet Minister with responsibility for post-war reconstruction had successfully pressed the cabinet to commission from the economist and social reformer William Beveridge.

The Beveridge Report offered three guiding principles to its recommendations:

  1. Proposals for the future should not be limited by "sectional interests" in learning from experience and that a "revolutionary moment in the world's history is a time for revolutions, not for patching".

  2. Social insurance is only one part of a "comprehensive policy of social progress". The five giants on the road to reconstruction were Want, Disease, Ignorance, Squalor and Idleness.

  3. Policies of social security "must be achieved by co-operation between the State and the individual", with the state securing the service and contributions. The state " should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family".

Beveridge was opposed to "means-tested" benefits. His proposal was for a flat rate contribution rate for everyone and a flat rate benefit for everyone. Means-testing was intended to play a tiny part, because it created high marginal tax rates for the poor (the "poverty trap").

This remarkable piece of work resulted in a White Paper during 1944. It fell to Clement Attlee's post war Labour government to create the NHS as part of the "cradle to grave" welfare-state reforms. In the aftermath of World War II when large areas of the UK industry and housing had been destroyed and the post war economy was in dire straights Aneurin Bevan, the newly appointed Secretary of State for Health, was given the task of introducing the National Health Service!

Healthcare in the UK prior to the war had been a patchwork quilt of private, municipal and charity schemes though half of the area (not population) of Scotland was covered by public provision. Bevan now decided that the way forward was a national system rather than a system operated by regional authorities, to prevent inequalities between different regions. He proposed that each resident of the UK would be signed up to a specific (GP) as the point of entry into the system, and would have access to any kind of treatment they needed without having to raise the money to pay for it.

The new NHS had at its heart three core principles:

  • That it meet the needs of everyone

  • That it be free at the point of delivery

  • That it be based on clinical need, not ability to pay

1948

NHS established

The NHS is born on July 5 1948 out of a long-held ideal that good healthcare should be available to all, regardless of wealth.

When health secretary Aneurin Bevan opens Park Hospital in Manchester it is the cllimax of a hugely ambitious plan to bring good healthcare to all. For the first time hospitals, doctors, nurses, pharmacists, opticians and dentists are brought together under one umbrella organisation that is free for all at the point of delivery. The central principles are clear: the health service will be available to all and financed entirely from taxation, which means that people pay into it according to their means.

1952

Prescription charges introduced

The cost of the new NHS soon took its toll on government finances. On 21 April 1951 the Chancellor of the Exchequer, Hugh Gaitskell, proposed that there should be a one shilling (5p) prescription charge and new charges for half the cost of dentures and spectacles. Bevan resigned from the Cabinet in protest. This led to a split in the party that contributed to the electoral defeat of the Labour government in 1951. The one shilling prescription charge was introduced in 1952 together with a £1 flat rate fee for ordinary dental treatment. Prescription charges were abolished in 1965, but reintroduced in June 1968.

1953

DNA structure revealed

Crick and Watson, two Cambridge scientists, reveal the structure of DNA in Nature Magazine.

On April 25 James D Watson and Francis Crick, two Cambridge University scientists, describe the structure of a chemical called deoxyribonucleic acid in Nature magazine. DNA is the material that makes up genes which pass hereditary characteristics from parent to child. Crick and Watson begin their article: "We wish to suggest a structure for the salt of deoxyribonucleic acid (DNA). This structure has novel features which are of considerable biological interest."  DNA allowed the study of disease caused by defective genes.

 1954

Smoking-cancer link established

Sir Richard Doll establishes a clear link between smoking and lung cancer.

In the 1940s, British scientist Doll begins research into lung cancer after incidences of the disease rise alarmingly. He studies lung cancer patients in 20 London hospitals, and he expects to reveal that the cause is fumes from coal fires, car fumes or Tarmac. His findings surprise him and he publishes a study in the British Medical Journal, co-written with Sir Austin Bradford Hill, warning that smokers are far more likely than non-smokers to die of lung cancer. Doll gives up smoking two-thirds of the way through his study and lives to be 92.

1954

Children get daily visits

Daily visits gradually introduced for children who until now had been allowed to see parents only at the weekend.

Until now children in hospital are often only allowed to see their parents for an hour on Saturdays and Sundays and are frequently placed in adult wards, with little attempt to explain to them why they are there or what is going to happen. Paediatricians Sir James Spence in Newcastle and Alan Moncriff at Great Ormond Street are making considerable steps to change this, demonstrating that such separation is traumatic for children. As a result, daily visiting is introduced gradually.

1958

Polio and diphtheria vaccinations

A programme to vaccinate everyone under the age of 15 against polio and diphtheria is launched.

One of the primary aims of the NHS is to promote good health, not simply to treat illness, and the introduction of the polio and diphtheria vaccine is a key part of the NHS’s plans. Before this programme, cases of polio could climb as high as 8,000 in epidemic years, with cases of diphtheria as high as 70,000, leading to 5,000 deaths. This programme sees everyone under the age of 15 vaccinated and will lead to an immediate and dramatic reduction in cases of both diseases.

  

1960

First kidney transplant

An Edinburgh doctor, Michael Woodruff, performs the first UK transplant involving an identical set of twins.

The first UK transplant takes place at Edinburgh Royal Infirmary on October 30 and involves a set of 49-year-old twins. The procedure is a success, with both donor and recipient living for a further six years before dying of an unrelated illness. Kidney transplants, which for many are a welcome alternative to a lifetime of regular dialysis, now enjoy a high success rate but demand outstrips supply due to an ageing population meaning an increased incidence of renal failure, while the number of donor organs available has fallen. 

1961

The Pill made available

The contraceptive pill is made widely available and is hailed as a breakthrough of the 20th Century.

The launch of the contraceptive pill, which suppresses fertility with either progesterone or oestrogen or, more commonly, a combination of both, plays a major role in women’s liberation and contributes to the sexual freedom of the so-called Swinging Sixties. Initially, it is only available to married women, but this is relaxed in 1967. Between 1962 and 1969, the number of women taking the Pill will rise dramatically, from approximately 50,000 to 1m.

1962

The Hospital Plan

Porritt Report is published and results in Enoch Powell's Hospital Plan.

The medical profession criticises the separation of the NHS into three parts – hospitals, general practice and local health authorities – and calls for unification. The Hospital Plan approves the development of district general hospitals for population areas of about 125,000. The 10-year programme is new territory for the NHS and it soon becomes clear that it has underestimated the cost and time taken to build new hospitals. But with the advent of postgraduate centres, nurses and doctors will be given a better future.

 1962


First hip replacement

First full hip replacement is carried out by Professor John Charnley in Wrightington Hospital.

Charnley begins to devote his energies to developing full hip replacements from 1958 and moves to the Wrightington Hospital where the first full hip replacement takes place. He asks his patients if they mind giving back the hip post-mortem. Apparently 99% of them agree, so his team would regularly collect the replacement hips to check wear and tear, and aid research. He improves his design with a low-friction hip replacement, and in November 1962 the modified Charnley hip replacement becomes a practical reality.

1967

The Salmon Report

This major report makes recommendations for the development of senior nursing staff.

The Salmon Report is published and sets out recommendations for developing the nursing staff structure and the status of the profession in hospital management. The Cogwheel Report considers the organisation of doctors in hospitals and proposes speciality groupings. It also highlights the efforts being made to reduce the disadvantages of the three-part NHS structure – hospitals, general practice and local health authorities – acknowledging the complexity of the NHS and the importance of change to meet future needs.

1967

Abortion Act

The Abortion Act is introduced by Liberal MP David Steel and is passed on a free vote, becoming law on April 27 1968.

This new act makes abortion legal up to 28 weeks if carried out by a registered physician and if two other doctors agree that the termination is in the best mental and physical interests of the woman. In 1990, the time limit is lowered to 24 weeks. The act does not extend to Northern Ireland.

 

1968

Sextuplets born

Sextuplets born after British woman receives fertility treatment.

In the morning of October 2 Sheila Thorns celebrates her birthday by undergoing a caesarean section at Birmingham Maternity Hospital. She gives birth to six children, four boys and two girls, but sadly one of the girls dies shortly afterwards. With 28 medical staff at the delivery, the five surviving babies – Ian, Lynne, Julie, Susan and Roger – are cared for by a specialist team. Doctors say around one birth in 3,000m will result in sextuplets. Mrs Thorns had been treated with the fertility treatment gonadotrophin which contains two hormones known as FSH and LH.

1968

First NHS heart transplant

A 45-year-old man becomes the first Briton to have a heart transplant on 3 May. 

Surgeon Donald Ross carries out Britain’s first heart transplant at the National Heart Hospital in Marylebone, London. Ross leads a team of 18 doctors and nurses to operate on the man in the seven-hour procedure. The donor was a 26-year-old labourer called Patrick Ryan. The British operation is the tenth heart transplant to be undertaken in the world since Christiaan Barnard carried out the first in Cape Town, South Africa, in December 1967. The patient dies after 46 days and only six transplants are carried out over the next 10 years.

1972

CT scans introduced

Computer tomography scans start to revolutionise the way doctors examine the body. 

These scanners produce 3-D images from a large series of two-dimensional X-rays and the first one is started in 1967 by Godfrey Newbold Hounsfield, with his research reaching fruition now. His concept will go on to win him a Nobel Prize, which he will share with the American Allan McLeod Cormack, who developed the same idea across the Atlantic. Since that initial invention, CT scanners have developed enormously, but the principle remains the same.

  1975

Endorphins discovered

The morphine-like chemicals in the brain called endorphins are discovered.

John Hughes and Hans Kosterlitz of Scotland isolate from the brain of a pig what they called enkephalins and will later be termed 'endorphin' from an abbreviation of 'endogenous morphine'. These are polypeptides produced by the pituitary gland and the hypothalamus in vertebrates, and they resemble opiates in their abilities to produce analgesia and a sense of well-being. In other words, they might work as natural pain killers.

1978

First test-tube baby

Louise Brown is the world’s first baby to be born as a result of in-vitro fertilization.

The world’s first test tube baby is born on July 25. Parents Lesley and John Brown had failed to conceive due to Lesley’s blocked fallopian tubes. This new technique developed by Dr Patrick Steptoe, a gynaecologist at Oldham General Hospital, and Dr Robert Edwards, a physiologist at Cambridge University found a way to fertilize the egg outside the woman’s body before replacing it in the womb.

1979

Bone marrow transplant

The first successful bone marrow transplant on a child takes place.

Professor Roland Levinsky performs the UK's first successful bone marrow transplant in children with primary immunodeficiency at Great Ormond Street Hospital for Children.

1980s

MRI scans introduced

Using a combination of magnetism and radio frequency waves, MRI scanners provide information about the body.

Magnetic resonance imaging scanners prove more effective in providing information about soft tissues, such as scans of the brain. The patient lies inside a large cylindrical magnet and extremely strong radio waves are then sent through the body. It provides very detailed pictures, so is particularly useful for finding tumours in the brain; it can also identify conditions such as multiple sclerosis and the extent of damage following a stroke.

 

1980

Keyhole surgery

A surgeon uses a telescopic rod with fibre optic cable to remove gallbladder. 

This first successful instance of keyhole surgery is the removal of a gallbladder. Technically it’s known as laparoscopic surgery, after the instrument that’s used to perform the surgery, a thin telescopic rod lit with a fibre optic cable and connected to a tiny camera which sends images of the area being operated on to a monitor. The procedure will go on to be one of the most common uses of this kind of surgery. It will also be used for hernia repairs and removal of the colon and the kidney.

1980

Black Report

Commissioned three years earlier by David Ennals the report aimed to investigate the inequalities of healthcare.

Commissioned three years earlier by David Ennals, then secretary of state, the report aims to investigate the inequality of healthcare that still exists despite the foundation of the NHS i.e. differences between the social classes in the usage of medical services, infant mortality rates and life expectancy. Poor people are still more likely to die earlier than rich ones. The Whitehead Report in 1987 and the Acheson report in 1998 reached the same conclusions as the Black Report.

1981

Improved health of babies

The 1981 Census shows that 11 babies in every 1,000 die before the age of one. In 1900 this figure was 160.

Childhood survival has been revolutionised by vaccination programmes, better sanitation and improved standards of living, resulting in better health of both mother and child. Increased numbers of births in hospital has meant that where unexpected problems do occur, medical help is on hand. Around one baby in eight requires some kind of special care following birth. Twenty years ago, only 20% of babies weighing less than 1,000g (2lbs 2oz) at birth survived. Now that figure is closer to 80%.

 

 1986

Aids health campaign

The government launches biggest public health campaign in history to educate people about the threat of Aids as a result of HIV.

Following a number of high-profile deaths, the advertising campaign sets out to shock – with images of tombstones and icebergs, followed early in 1987 by a household leaflet, “Don’t die of ignorance”. This was very much in keeping with the NHS’s original concept that it should improve health and prevent disease, rather than just offer treatment.

1987

Heart, lung and liver transplant

First heart, lung, and liver transplant is carried out at Papworth Hospital.

Professor Sir Roy Calne and Professor John Wallwork carry out the world’s first liver, heart and lung transplant at Papworth Hospital in Cambridge. Professor Calne describes the patient as “plucky” and she survives for a further 10 years after the procedure. Her healthy heart is donated to another transplant patient.

1988

Breast screening is introduced

Comprehensive national breast-screening programme introduced.

To reduce breast cancer deaths in women over 50 this project is launched with breast-screening units around the country providing mammograms. A mammogram works by taking an X-ray of each breast, which can show changes in tissue that might be otherwise undetectable. This means that any abnormalities show up as early as possible, making treatment more effective. Screening, together with improved drug therapies will help to cut breast cancer deaths by more than 20%, a trend that looks set to continue.

1990

NHS and Community Care Act

Internal market is introduced, which means health authorities manage their own budgets.

Now health authorities will manage their own budgets and buy healthcare from hospitals and other health organisations. In order to be deemed a "provider" of such healthcare, organisations will become NHS Trusts, that is, independent organisations with their own managements.

 

1991

First NHS Trusts established

Fifty-seven NHS trusts are established to make the service more responsive to the user at a local level.

New NHS Trusts will aim to encourage creativity and innovation and challenge the domination of the hospitals within a health service that is increasingly focused on services in the community.

1994

NHS Organ Donor Register

National register for organ donation is set up to co-ordinate supply and demand after a five-year. campaign

The NHS Organ Donor Register is launched following a five-year campaign by John and Rosemary Cox. In 1989 their son Peter died of a brain tumour. He had asked for his organs to be used to help others. The Coxes said that there should be a register for people who wish to donate their organs. By 2005 more than 12m had registered. Organ donation is needed as demand outstrips supply and this register ensures that when a person dies they can be identified as someone who has chosen to donate their organs.

1998

NHS Direct launches

A nurse-led advice service provides people with 24-hour health advice over the phone.

This service will go on to become one of the largest single e-health services in the world, handling more than half a million calls each month. It is the start of a growing range of convenient alternatives to traditional GP services – including the launch of NHS walk-in centres, which offer patients treatment and advice for a range of injuries and illnesses without the need to make an appointment.

2000

NHS walk-in centres

New health facilities open offering convenient access, round-the-clock, 365 days a year.

NHS walk-in centres (WiCs) offer convenient access to a range of NHS services and are managed by Primary Care Trusts. There are around 90 NHS WiCs dealing with minor illnesses and injuries. WiCs are predominantly nurse-led first-contact services available to everyone without making an appointment or requiring patients to register. Most centres are open 365 days a year and are situated in convenient locations that give patients access to services even beyond regular office hours.

 2002

Primary care trusts launched

Primary care trusts are set up to improve the administration and delivery of healthcare at a local level.

The primary care trusts oversee 29,000 GPs and 21,000 NHS dentists. primary care trusts that are in charge of vaccination administration and control of epidemics also control 80 per cent of the total NHS budget. They also liaise with the private sector when contracting out of services is required. As local organisations, they are best positioned to understand the needs of their community, so they can make sure that the organisations providing health and social care services are working effectively.

2004

Patient Choice Pilots 

All patients waiting longer than six months for an operation are given a choice of an alternative place of treatment.

Everyone who is referred by their doctor for hospital treatment is given a choice of at least four hospitals. Nowadays you can choose where and when to have your treatment from a list including local hospitals, NHS foundation trust hospitals across the country and a growing number of independent sector treatment centres and hospitals that have been contracted from the private sector. You can choose according to what matters most to you: waiting lists, MRSA rates, bus routes and so on.

2007

Robotic intervention

Introduction of robotic arm leads to groundbreaking operations to treat patients for fast or irregular heartbeats.

This technological revolution is being used at St Mary’s Hospital, London, and is less risky than more invasive techniques. It works by inserting several fine wires into a vein in the groin, which are then guided to the heart where they deliver an electric current to parts of the heart muscle. Cardiologists control the robot arm via a computer and joystick, but in future the system could be automated. Around 50,000 people develop an irregular heartbeat each year, and it is a major cause of strokes and heart attacks.