Celebrating 75 Years of the NHS:
A timeline

Since its inception in 1948, the National Health Service (NHS) has played a crucial role in providing accessible healthcare to millions in the United Kingdom. Over its history, the NHS has undergone significant changes, impacting the lives of both patients and healthcare professionals. To celebrate 75 years of the organisation, join us as we take a journey through time to explore some key milestones that shaped one of the world’s most recognisable health systems.

Pre-1948

Pre-1948 – Out of the frying pan, into the fire

Although the NHS as we know it would not take shape until much later in the decade, in 1942, a report by economist Sir William Beveridge, written during the darkest days of WWII, laid out a revolutionary idea for a post-war nation that would provide the blueprint for social policy in Britain.

“A revolutionary moment in the world’s history is a time for revolutions, not for patching,” he wrote.

Public hunger for change had been mounting for some time. Before the NHS, general practice covered workers aged between 16 and 70 under the National Insurance Act of 1911, but this did not extend to their families or children, for whom medical attention came hand in hand with a hefty price tag. Even those who could afford the expense were not guaranteed treatment. Underfunding and the ravages of war had reduced the health service to near bankruptcy.

Pain and discomfort were widely considered an unpleasant reality of life, to be endured with the famed British stiff upper lip mentality. But after two world wars, the nation was ripe for change – beginning with the government.

When Clement Attlee’s Labour party won the 1945 general election, the creation of a national health system was a top priority. Charismatic Welshman Aneurin “Nye” Bevan was tasked with bringing this ambitious vision to life as the new health minister. He set out three founding principles around which the new health service would be built: that it should be available to all, regardless of wealth or status, that it be free at the point of delivery, funded via general taxation, and with responsible application.

National Health Service leaflet, May 1948. Image courtesy of The National Archives, public domain, via Wikimedia Commons

On the surface, these all seem highly uncontroversial proposals, and yet, almost immediately, Bevan found himself fighting an uphill battle. Not only was much of the country’s healthcare infrastructure war-damaged, but fierce opposition raged from all fronts: consultants, doctors, the Conservative Party, and even his own peers in the Labour cabinet.

For the next three years, Bevan battled the British Medical Association (BMA) at the negotiating table. The conflict grew increasingly public as each side traded blows in the media – Bevan was denounced as “a complete and uncontrolled dictator” and the BMA accused of engaging in “a squalid political conspiracy”. Finally, after the BMA threatened to boycott the new service in 1947, a deal was brokered. General practitioners would retain control over their surgeries, operating as a small business, while consultants could both work for the service and retain their private patients. As a disgruntled Bevan put it, he “stuffed their mouths with gold”.

1948

1948 – A bold new beginning

At just 13 years old, it’s unlikely that little Sylvia Diggory wholly understood her importance in British history when she was admitted to Park Hospital (now Trafford General Hospital) in Manchester for liver problems on 5th July 1948. As the first patient to be treated on the NHS, Diggory received an unusual visitor at her bedside – Aneurin Bevan, the health minister himself, had come to meet the little girl whose treatment would signal a turning point for healthcare in the UK.

With the service now in operation, for the first time, the UK Government assumed responsibility for the provision of preventative and curative healthcare services for the entire population.

To the outside observer little had changed – at least superficially. The arrival of the NHS brought with it no additional doctors or nurses to mark the transition; rather, a tectonic shift in the way that healthcare functioned in the UK. Its impact may not have been immediately apparent, but the waves of change were in motion, to be felt for years to come.

Aneurin Bevan, Minister of Health, on the first day of the National Health Service. Image Courtesy of University of Liverpool Faculty of Health & Life Sciences from Liverpool, United Kingdom, CC BY-SA 2.0 , via Wikimedia Commons

1950s

1950s – The cost of a cure

Unfortunately, as is often the case, expenditure quickly exceeded predicted expectations. With an expected cost of £176 million, it seemed that architects of the NHS had significantly underestimated just how in demand the service would be. In fact, by the end of 1948, initial estimates would be utterly dwarfed by the nearly £400 million price tag.

To manage rising costs, in the early 1950s, Prime Minister Clement Attlee’s government proposed charging patients for prescriptions, glasses, and dental care, alongside plans to transfer money from the National Insurance Fund to finance rearmament.

For Bevan, by now the labour minister, this decision was a step too far. Sticking by his staunch opposition to any imposed charges on the NHS, in 1951 Bevan resigned. His parting remarks before Parliament made clear his position on the proposed cuts as he chastised then Chancellor of the Exchequer Hugh Gaitskell’s plan to “mutilate” the health services, stating, “The Health Service will be like Lavinia – all the limbs cut off and eventually her tongue cut out, too.”

While Gaitskell and the broader Attlee administration would be ousted from power only a few months later, plans to introduce charges remained. In 1952, the newly elected Conservative government, led by Winston Churchill, recommended a one shilling (5p by today’s standards) prescription charge, a two-pence increase in national insurance contributions, hospital ‘amenity’ charges, and charges for dental treatment.

Young Red Cross nurses, 1950s
Young Red Cross volunteers from London in training at a hospital. Image courtesy of British Red Cross via Flickr

In the years following Bevan’s departure, the NHS continued to thrive as discoveries and capabilities expanded the range of available treatments. Perhaps the most notable came from a group of rather ordinary scientists – and one extraordinary discovery.

In 1953, James D Watson and Francis Crick, with invaluable contributions from Rosalind Franklin and Maurice Wilkins, developed a model for a helical structure of DNA. Their discovery proved to be one of the most important scientific breakthroughs to date and helped to revolutionise the study of disease and enhance medical treatment in the NHS and abroad.

The NHS continued to make significant achievements late into the 1950s. Throughout the decade, antibiotics became more widely available for civilian use. These medications became a cornerstone of modern medicine, used to treat a wide range of bacterial infections, including pneumonia, urinary tract infections, and skin infections. Moreover, in 1958, a staple feature of primary care was born, introducing routine vaccination programmes for children under 15. The first such effort, which targeted polio and diphtheria, proved highly successful, dramatically reducing cases of both illnesses.

1960s

1960s – Breaking the norm

The decade kicked off with a bang as, in late 1961, then Minister for Health Enoch Powell (yes, that Enoch Powell) announced to the House of Commons that ‘birth control pills’ could now be prescribed on the NHS.

This decision to provide contraceptive services represented a significant departure from the past reluctance to offer birth control through the NHS. The contraceptive pill, a revolutionary breakthrough in reproductive health, played a pivotal role in this change. Developed during the 1950s by American scientists led by Dr Gregory Pincus and championed by women’s rights campaigner Margaret Sanger, the pill, known as Enovid in the USA, was licensed in 1960. Clinical trials conducted in Birmingham, Slough, and London during 1960 paved the way for its approval by the Ministry of Health for availability on the NHS.

With the pill’s inclusion in NHS services, the early 1960s witnessed a rapid increase in prescriptions from general practitioners. The market saw the emergence of multiple brands, with the number of available brands growing from five in 1963 to fifteen in 1966. This accessibility resulted in a surge of patients seeking birth control pills through their GP surgeries. By 1970, approximately 700,000 married women between the ages of 16 and 40 were obtaining the pill through their GPs, marking a significant shift in family planning.

Bottle of Enovid 10mg Oral Contraceptive. Image courtesy of Science History Institute, public domain, via Wikimedia Commons

While the contraceptive pill was breaking the mould of reproductive healthcare, the 1960s also witnessed significant progress in the field of organ transplantation. The decade saw the first successful kidney transplant at Edinburgh Royal Infirmary, involving identical twins. Additionally, in 1968 South African-born surgeon Donald Ross conducted the first heart transplant at the National Heart Hospital in London. Furthermore, in a first for Europe, Professor Sir Roy Calne performed the Continent’s first liver transplant at Addenbrooke’s Hospital in Cambridge.

1970s

1970s – CT scans and IVF pioneers

In 1972, a medical breakthrough revolutionised the way doctors examined the human body. The introduction of CT scans allowed for the production of three-dimensional images from a series of two-dimensional X-rays. This innovation provided clinicians with a powerful tool to diagnose and treat a wide range of medical conditions, greatly enhancing the precision and effectiveness of healthcare.

One of the most iconic moments in the history of the NHS occurred in 1978, when Louise Brown, the world’s first test-tube baby, was born. This remarkable achievement was the result of in-vitro fertilisation (IVF), a pioneering technique developed by Dr Patrick Steptoe. IVF opened up new possibilities for couples struggling with infertility and reshaped the landscape of reproductive medicine.

Amidst these medical breakthroughs, the NHS underwent a significant transformation in 1974, following the enactment of the NHS Reorganisation Act 1973. This legislation represented a sweeping structural and administrative reform of the healthcare system. It unified the previously separate administrative structures for hospital services, family practitioner services, and personal health services into a single, integrated system.

CT scan showing bilateral pleural effusions. Image courtesy of Laskaridis L1, Kampantais S, Toutziaris C, Chachopoulos B, Perdikis I, Tahmatzopoulos A, Dimitriadis G, CC BY 3.0 , via Wikimedia Commons

The Act abolished regional hospital boards and hospital management committees, replacing them with regional health authorities (RHAs) and 90 area health authorities (AHAs). These new entities were entrusted with the planning and delivery of healthcare services, streamlining the management of the NHS. Moreover, the Act vested the Secretary of State for Health and Social Security with responsibility for school health, consolidating healthcare oversight.

1980s

1980s – A changing of the guard

The 1980s were a pivotal period in the history of the NHS, marked by a unique blend of challenges, resilience, and groundbreaking research, particularly in the context of the emerging HIV/AIDS epidemic.

At the outset of the 1980s, the NHS was already grappling with financial constraints that demanded efficiency improvements and cost-saving measures. The need to allocate resources effectively became more critical than ever.

The NHS faced a defining moment in 1983, following an inquiry into the effective use and management of manpower and resources. Authored by Sir Roy Griffiths, a director of J Sainsbury’s plc, the Griffiths Report made several recommendations that led to the introduction of general management in the NHS.

Major shifts of power occurred following the introduction of general management, with the introduction of the health services supervisory board and, later, the NHS Management Board putting an end to the era of consensus management.

In another highly controversial move, the government, led by Prime Minister Margaret Thatcher, introduced the contentious ‘Internal Market’ reforms. This policy aimed to introduce competition within the NHS, with the goal of improving efficiency and care quality. These reforms generated passionate debates within the healthcare community, with some fearing that they might compromise the core principles of a publicly funded healthcare system.

Prime Minister Margaret Thatcher arriving at 10 Downing Street in London after winning the 1979 general election. Image courtesy of Press Association via Flickr

While these challenges persisted, the 1980s also witnessed notable achievements in the field of medical research and patient care. As the HIV/AIDS crisis unfolded globally, the NHS played a significant role in HIV research and care. In 1983, the NHS established specialised clinics to provide comprehensive care and support for HIV-infected individuals, contributing to the early understanding and management of the disease.

Furthermore, the NHS actively participated in HIV/AIDS research, collaborating with international partners to develop treatments and therapies. These efforts would eventually lead to significant breakthroughs in the fight against HIV/AIDS.

1990s

1990s – Enter the ‘NICE’ era

With the advent of the 1990s, the NHS witnessed significant progress in pharmacological advancements. New drugs, such as statins for cholesterol management and proton pump inhibitors for acid reflux, transformed the treatment of chronic conditions.

The 1990s also marked a change in the way that organ donation is conducted in the UK. Although organ donor cards had been in use since the late 70s, there was no central donor registry, which meant that those without cards or informed next-of-kin, may not be able to donate, even if they would have chosen to. Following a five-year public campaign, the NHS Organ Donor Register was set up in 1994 for people wishing to donate their organs.

For nearly 50 years, decisions surrounding which drugs qualified for funding were typically made at the local level. However, there were growing concerns that patients across the country were being denied treatments that other areas could access. Dubbed the ‘postcode lottery’, this inequality in prescribing fuelled demand for a nationwide approach to determining what therapies should be available on the NHS.

In 1999, this call for change was answered in the form of the National Institute for Clinical Excellence (now known as the National Institute for Care Excellence) – or NICE, for short.

With Sir Michael Rawlins appointed NICE’s first chairman, and Sir Andrew Dillon named the chief executive, the organisation got off to a rapid, and rather tumultuous start. Just a few months after being established, NICE set to work on conducting its first drug appraisal – an antiviral treatment for flu, developed by one of the world’s most influential pharmaceutical companies. After a robust review, NICE determined that there was not enough evidence to show the drug reduced the severity of the illness, that it wasn’t cost effective, and that it therefore should not be used by the NHS.

Unsurprisingly, said pharma company was not overly pleased with this outcome, with a chairman reportedly threatening to consider transferring the business out of the UK unless the decision was overturned. However, this controversial move cemented NICE as a tough, but fair sparring partner for the pharma industry.

2000s

2000s – A new millennium

The NHS embraced the digital age moving into the new millennium. In 2000, the organisation added to its ongoing NHS Direct pilot programmes in contact centres around England, until the entire country was covered by the telephone service. The same year the NHS direct website launched, empowering patients to access reliable health information online, and inadvertently foreshadowing the growth of telehealth and telemedicine services.

Amid these milestones, the 2000s also saw Great Ormond Street Hospital (GOSH) launch the world’s first gene therapy trials for children born without functioning immune systems. Dubbed ‘bubble boy’, by the media, due to his vulnerability to even the most minor infection, Rhy Evans was just a year old when he became the first child in the UK to be treated with gene therapy. At the time, children with his condition – Severe Combined Immunodeficiency – had a life expectancy of one to two years. Thanks to this pioneering treatment, and the staff at GOSH, Evans is now in his 20s.

Furthermore, the decade was defined by the ambitious 2000 NHS Plan, which outlined a strategic vision to modernise and improve healthcare services. This comprehensive plan aimed to reduce waiting times, enhance patient care, and introduce new treatments and services. The plan also marked an important step in establishing closer relationships between the private sector and the NHS to make better use of the facilities in the private sector.

2010s

2010s – Genomic medicine revolution

The 2010s marked a turning point in cancer treatment, with the rise of immunotherapy. The NHS championed groundbreaking immunotherapies, harnessing the body’s immune system to combat cancer cells, and offering hope to patients with previously untreatable malignancies.

For patients in Scotland, the decade began with celebrations, as the Scottish Government announced the abolishment of prescription charges. However, this only applies to those issued on Scottish prescription forms (GP10) and dispensed in Scottish pharmacies.

One year later, in 2012, the UK announced the launch of the 100,000 Genomes Project, an ambitious initiative led by Genomics England, which aimed to sequence 100,000 whole genomes from cancer patients and individuals with rare diseases. NHS England established 13 NHS Genomics Medicine Centres across the country, enabling patients and family members to participate, and establishing the infrastructure to make genomic medicine a routine part of NHS care. Five years later, in December 2018, news broke that the programme had reached its goal, becoming the first nation in the world to apply whole genome sequencing at scale in direct healthcare.

Not content with advancing personalised healthcare, in 2013 the NHS established the Cancer Drugs Fund. This national initiative compiled a comprehensive list of fast-track drugs, ensuring uniform access to cutting-edge cancer treatments across the entire country. Patients, no matter where they lived, could now benefit from the latest therapies, offering newfound hope in the battle against cancer.

Building on the groundwork of HIV treatments developed over previous decades, in 2017 NHS England embarked on the world’s largest PrEP (Pre-Exposure Prophylaxis) implementation trial to combat HIV infection. This groundbreaking effort demonstrated the NHS’s commitment to tackling public health challenges head-on and protecting vulnerable populations.

As the decade drew to a close in 2019, the NHS unveiled its Long-Term Plan, introducing Primary Care Networks. This ambitious initiative aimed to enhance the coordination of care and improve patient outcomes. With a commitment to invest at least £4.5 billion over the next five years, the NHS signalled its dedication to ensuring that healthcare remained at the forefront of innovation.

2020s

2020s – Navigating the pandemic

The 2020s commenced with a historic global challenge – the COVID-19 pandemic. In December of 2019, the first known case of COVID-19 was reported in the UK. This marked the beginning of an international public health crisis that would profoundly impact healthcare systems worldwide, with the NHS at the forefront of the battle.

As NHS workers soldiered on to battle the virus and the general public took to the streets in a rare showcase of united public support, a glimmer of hope emerged in December 2020, when 90-year-old grandmother Margaret Keenan made history: she became the first person in the world to receive the Pfizer COVID-19 jab outside of a clinical trial. This milestone heralded the start of the COVID-19 vaccination campaign, a monumental effort to protect the population against the virus.

In the midst of the pandemic, the NHS continued to prioritise innovation and patient care. In 2022, NHS England struck a groundbreaking deal for what was dubbed the ‘world’s most expensive drug’. As a result of this agreement, the gene therapy Libmeldy offered newfound hope to babies and young children suffering from metachromatic leukodystrophy (MLD), an extremely rare hereditary disorder that over time causes the nerves in the brain and other parts of the body to malfunction.

Furthermore, the NHS made a significant stride in healthcare access, with the launch of the Innovative Medicines Fund. This initiative aims to expedite patient access to promising new drugs, recognising the importance of timely and innovative treatments.

NHS superhero street art on Hilly Fields, Brockley, South London. Image courtesy of Loco Steve via Flickr

2023

2023 – An uncertain future

Over the course of 75 years, the NHS has evolved into a beacon of exemplary healthcare, touching the lives of millions and continually pushing the boundaries of medical innovation.

As of 2023, the NHS is one of the largest employers in the world, employing 1.6 million people and treating an estimated one million patients every 36 hours.

It may not be perfect, and there is much work to be done to preserve those core values set out by its creators, but we look forward to a future where the NHS continues to lead the way in shaping the healthcare landscape for generations to come.

Photos taken at the Nurses’ Protest at Trafalgar Square on Saturday 12 September 2020. Image courtesy of Garry Knight via Flickr

Eloise McLennan is the editor for pharmaphorum’s Deep Dive magazine. She has been a journalist and editor in the healthcare field for more than five years and has worked at several leading publications in the UK.

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Celebrating 75 Years of the NHS: A timeline