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nurse with incubator

child in hospital bed

nurses in classroom 1954


'1948 - 1957'

The National Health Service became reality on 5 July 1948. It was a momentous achievement and everybody wanted the new service to work.

However, food was still rationed, building materials were short, there was a dollar economic crisis and a shortage of fuel. The war had created a housing crisis - alongside post-war re-building of cities, and the designation of overspill areas, the New Towns Act (1946) created major new centres of population and all needed health services.

The NHS brought hospital services, family practitioner services (doctors, pharmacists, opticians and dentists) and community-based services into one organisation for the first time. But it was not easy. Holding everything together and keeping everyone on board continued to create administrative difficulties for years.

Financial problems, however, were worse. It was impossible to predict the day-to-day costs of the new service and public expectations rose. Medical science was rapidly gathering pace, hospital beds for tuberculosis were closed, allowing cash to be released for other services.

More mothers were wanting their babies delivered in hospital, cardiac surgery was being applied to rheumatic heart disease, and the first hip replacements were beginning to be performed.

But initial estimates of the cost of the NHS were soon exceeded as newer, more expensive and more frequently used drugs were developed.

Within three years of its creation, the NHS, which had been conceived as free of direct charges for everyone, was forced to introduce some modest fees. Prescription charges of one shilling (5p), which had been legislated for as early as 1949 but had not been implemented, were introduced in 1952. A flat rate of £1 for ordinary dental treatment was brought in at the same time.

Many of the tensions that emerged in the early days of the NHS have challenged its senior management and successive Governments ever since. Today the NHS has a workforce of over one million people and a budget of around £42 billion year - it is a sophisticated and modern organisation with all the advantages of state-of-the-art technology. Yet, the fundamental questions that tested Bevan and his colleagues - how best to organise and manage the service, how to fund it adequately, how to balance the often conflicting demands and expectations of patients, staff and taxpayers, how to ensure finite resources are targeted where they are most needed - continue to challenge the system.

Bevan foresaw this. We shall never have all we need he said. Expectations will always exceed capacity. The service must always be changing, growing and improving - it must always appear inadequate.

The foundation of the new service was the family doctor or general practitioner (GP). Then, as now, the family doctor acted as µgate-keeper to the rest of the NHS, referring patients where appropriate to hospitals or specialist treatment and prescribing medicines and drugs.

Dental services consisted of check-ups and all necessary fillings and dentures. There was a school dental service and a special priority service for expectant and nursing mothers and young children that was organised by local authorities. Eye tests were provided by ophthalmic opticians on production of a GP referral note.

A major innovation was the community health centres - a special premise with accommodation and equipment supplied from public funds to enable family doctors, dentists and others to work together to provide a range of services on the spot. There were also specialist ear clinics at which patients could get an expert opinion and, if needed, a new hearing aid.

Excerpt taken from From Cradle to Grave by Geoffrey Rivett. Published by the King’s Fund, 1998. (http://www.kingsfund.org.uk/) ISBN: 1-85717-148-9. Price: £25.00. Available from selected bookshops and the King’s Fund bookshop. Tel: 0171 307 2591.

Photo Credit: Wellcome Trust


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