Public Health (20thC)

Liberal Reforms

1911 National Insurance Act – sick pay


Partway through the Second World War in 1942 the British government were seriously beginning to think about how medical care should be organised when the war ended. William Beveridge, who worked for the government, did some research and concluded that there were five “giant evils” in British society that needed fixing in order to have a healthy population. They were: want, idleness, disease, ignorance, squalor.

WANT: Referred to poverty and the need to deal with it as it lead to poor health

IDLENESS: People who could work, but chose not to should be dealt with in some way

DISEASE: The spread of disease was still not under control, especially in poor areas

IGNORANCE: A lack of education – too many children still didn’t attend school

SQUALOR: People were living in overcrowded “squalid” living conditions

Beveridge put forward his ideas to the government for a free national health service that would feed off the already existing National Insurance Scheme. It’s aim was to banish want “from the cradle to the grave”.

1946: The National Health Service Act was passed declaring that a comprehensive health service would be set up with services free at the point of delivery.

1948: 5th July was the first day of the NHS: it formalised the nationalisation of hospitals (when something is nationalised it means it is taken over by the government for the nation), it created health centres, doctors were distributed more evenly across the country and a new salary structure was introduced for doctors.

It aimed to be comprehensive in two ways:

  1. Available to all people
  2. Covered all necessary forms of health care

The NHS was to be run by the government. The NHS was in control of medical training and medical research.


  • Maternity and child welfare
  • Health visitors
  • Nursing homes and the after-care of the sick
  • Health centres
  • Vaccinations
  • Ambulance service
  • Family doctors (GP)
  • Medicines and medical equipment
  • Dentists
  • Blood transfusions
  • Optometry (eyes)
  • Specialist consultants in hospitals (including surgeons)
  • Hospitals in general


It was a major and sudden change and like in previous time periods people were reluctant to make changes. The government minister (MP) who was appointed to introduce the NHS was called Aneurin Bevan, an ex-miner from south Wales with a reputation for being rebellious and outspoken!

  1. Local authorities: the 3000 hospitals in Britain were taken over by the government when previously the local authorities were in charge – they didn’t like the power and responsibility taken away from them.
  2. Cost: Arguments raged across all levels of society about the cost. Bevan agreed it would be an enormously expensive exercise but that the country should and could afford it
  3. The BMA (British Medical Association): the strongest opposition came from here. The BMA represented the medical profession. Doctors didn’t want to be employed by the government and be told where to work. They feared a loss of income because they could no longer sell their services at whatever price they could get. The BMA ran a survey in 1946 and 54% of its members said they would refuse to co-operate with the NHS, by January 1948 this had risen to 90%.

Bevan responded by using his powerful personality to win over many members of the medical profession.

“Medical treatment should be made available to rich and poor alike in accordance with medical need and no other criteria”

He gained the support of hospital consultants (many of them surgeons) by promising them a high enough salary and allowing them to treat private patients in NHS hospitals. That’s why now if you can afford to pay you can get an appointment/surgery quicker. He also showed great willingness to talk to doctors about the smaller issues. By the time the NHS was finally introduced in July 1948, 90% of doctors had signed up.


Impact on Women

It made women’s health a priority and continues to do so. Women are now four times more likely to consult a doctor than a man. Life expectancy for a woman has risen from 66 to 78 since 1948. Maternal mortality (women dying in childbirth) reduced significantly.

Family Doctors

GPs increasingly work as part of teams offering a whole range of health services, whereas before the NHS most GPs worked on their own.


COST: As medicine and medical care advanced rapidly in the twentieth century the cost of providing the most up-to-date medicine on offer has increased. As people lived longer due to better medical care so the cost of one person’s medical care went on for much longer than when the NHS first started.

Compromises had to be made to keep the system going. Prescription charges were introduced in the early 1950s. Charges for dental treatment were gradually introduced.

Despite rising costs it is still a cheaper system than others. For example, the USA has a private health care system which costs 12% of national income, whereas the NHS costs just 6%.