Front cover of the 1948 leaflet launching the UK's new National Health System.

70 Years of the UK National Health Service

2018 sees the 70th Anniversary of the UK National Health Service (NHS). Launched on 5th July in 1948, the NHS was born out of changing attitudes to social welfare following the Second World War and the influential Beveridge Report of 1942, is still considered a landmark document. The report identified five giants to postwar reconstruction in Britain, ignorance (lack of education), disease (poor health), squalor (poor housing), want (poverty) and idleness (unemployment). The moving account of Life in Britain before the NHS, by veteran NHS campaigner Harry Leslie Smith, aged 95, gives an insight into the times that led up to the demand for social change after World War II.

The findings of the Beveridge Report underpinned the establishment of a welfare state in Britain based on universal principles and the NHS formed a substantial component of this. The NHS was based upon three key 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.

These principles still underpin the NHS today and have been added to. Principle one has been more clearly defined by NHS Choices to emphasise that the NHS ‘has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population’.

At the start of the millennium, the UK health system was ranked 18th out of 191 countries by the WHO, spending just six percent of GDP on health services. A more recent study by The Commonwealth Fund, 2017 put the UK first out of eleven high income countries, scoring first place on both equity and ‘care process’, which incorporates prevention, safety, coordination and patient engagement, and ranking third on access. However, it finished only above the United States for health care outcomes despite experiencing the fastest reduction in deaths amenable to health care in the past decade. This is because of higher death rates from conditions that could have been prevented if timely and effective care had been provided and due to lower healthy life expectancy at age 60.

As the NHS enters its 70th year under increasing pressure to provide more care to an ageing population, political and public debates continue over levels of funding, how additional funding is used to transform services and the growing use of private organisations to provide care for patients. Increasingly the need to integrate wider social care with health care is argued for to address issues such as bed blocking leading to lengthy discharge times for patients. This increases pressures on accident and emergency departments (A&E) during the winter months, with some hospitals cancelling non-urgent operations so as to meet the resource needs of A&E departments.

In the run up to the Fifth Global Symposium on Health Systems Research in Liverpool this October, we will be exploring some of the history of the National Health Service through a number of projects and activities, and look forward to welcoming the NHS at 70 project to the Symposium’s marketplace to share stories of people who have worked or been cared for by the NHS. As hosts of the Global Symposium we would like participants to be able to join in these celebrations and share experiences of other health systems around the world with that of the UK. The call for photovoice projects for HSR will allow the sharing of people’s experience of different health systems around the world. These will be displayed in the symposium venue and also in the Museum of Liverpool, so that the wider public can also engage with the images and descriptions.

Image credit: Wellcome Library, London

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