NHS History

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United Kingdom Specific

  • The United Kingdom NHS as a concept orginated in the 1944 White Paper "A National Health Service". The aims were:
    1. To ensure that everyone in the country "irrespective of means, age, sex or occupation" should have equal opportunities in securing the medical care they needed.
    2. To provide a comprehensive health service covering all aspects of preventive and curative medicine.
    3. To divorce the care of health from questions of personal means and to provide the service free of charge (apart from certain possible charges in respect of appliances).
  • Following the election of the first Labour government in 1945, the debate intensified and in 1946 the National Health Service Act was passed.
  • Municipal and voluntary hospitals were transferred to the State on July 5th 1948.
  • A General Practice contract was established.
  • Sylvia Beckingham aged 13 became the first ever NHS patient at Park Hospital, subsequently Trafford General Hospital on that day.

It is a political animal so we detail:

The time line below is divided into political administrations as these actually have had a major influence on implementation of the advice of the many reports that have shaped the NHS (see also NHS scandals).[1][2] The colour coding is Green: National/coalition government, Yellow: Liberal, Red: Labour, Blue, Conservative.

  • 1911 National Health Insurance Act
  • 1920 Medical Advisory Committee to Minister of Health produced outline plan for an National Health Service
  • 1921 Voluntary hospitals and their services: final report - Cave Report
  • 1929 First Local Government Act helping to end the Poor Laws and separating hospital component from welfare service
  • 1933 Second Local Government Act ending the Poor Laws. A General Medical Service for the Nation from the British Medical Association
  • 1939 Emergency Medical Service established, Cancer Act introduced concept of regionalisation into public health care
  • 1942 Medical Planning Commission of the British Medical Association and Royal Colleges produced interim report. Report on Social Insurance and Allied Services - The Beveridge Report.
  • 1944 White paper A National Health Service.
  • 1945 Aneurin Bevan proposes full central control of Health Services
  • 1946 NHS Act has Royal assent in November, Report of the Inter-departmental Committee on the Remuneration of General Practitioners - Spens Report
  • 1947 Regional Health Boards appointed. Confidential negotiations with medical profession.
  • 5 July 1948 Creation
  • 1949 Prescription charges. NHS (Admendment) Act
  • 1950 Medicine Act creates pre-registration year for Doctors
  • 1951 Charges for dental and optical appliances, Only midwives or a registered medical practitioner can attend a woman in childbirth,
  • 1952 Charges for dental treatment. Pay reform for General Practice encouraging partnerships and intermediate list sizes. Smallpox outbreak. First hospital manpower crisis - too many senior registrars in Medicine and Surgery results in Willink Committee underestimating needed medical school intake
  • 1953 Births and Deaths Registration Act
  • 1954 Internal administration of hospitals - Bradbeer Report
  • 1956 Report of the committee of enquiry into the cost of the National Health Service. - Guilebaud Report, Reform of General Medical Council.
  • 1957 Royal Commission on Remuneration of Doctors and Dentists
  • 1959 Report of the Maternity Services Committee - Cranbrook Report, The welfare of children in hospital: Report of a Committee of the Central Health Services Council - Platt report.
  • 1960 Royal Commission on Doctors' and Dentists' Remuneration. Report - Pilkington Royal Commission allows rent allowance to General Practitioners
  • 1962 Platt Committee report on medical staffing structure in the hospital service
  • 1963 Field of work of the family doctor - Gillie Report
  • 1964 Platt Committee report on reforming nursing education
  • 1965 Prescription charges abolished
  • 1966 New GP contract. First report of the Joint Working Party on the Organisation of Medical Work in Hospitals - First Cogwheel Working Party report, Report of the committee on senior nursing staff structure - Salmon report
  • 1967 Abortion Act, Report of the Committee of Inquiry into the relationship of the pharmaceutical industry with the National Health Service - Sainsbury Report
  • 1968 Prescription charges re-introduced. The administrative structure of the medical and related services in England and Wales, - the first Green Paper meets with reistence on point of abolishing regions, Todd Royal Commission report on Medical Education overestimates medical school intake. Royal Commission on Local Government in England suggests unifying NHS within the new system of local government
  • 1969 Department of Health report The Responsibilities of the Consultant Grade - The Tomato Document, Functions of the District General Hospitals - Bonham-Carter Report, Reform of General Medical Council.
  • 1970 Hospital Advisory Service established. The future structure of the National Health Service in England - the second Green Paper proposes regional councils and Area Health Authorities (AHAs)
  • 1971 National Health Service reorganisation: consultative document defines Regional Health Authorities RHAs and AHAs
  • 1972 Report of the Committee on Nursing - Briggs report, Report of the Working Party on Medical Administrators - Hunter report
  • 1973 Three day working week. Third Cogwheel Working Party report, Barbara Castle proposes to phase out Pay beds
  • 1974 Health service reorganisation - RHAs, AHAs and Health Districts unify hospital services, family practitioner services and local authority health services. Community health councils (CHCs) created. Gray book outlines health service planning system and defines roles in management with precision promoting management by consensus, Health Ombudsman
  • 1975 Report of the Committee on mentally abnormal offenders - Butler Report
  • 1976 Cash limits introduced into the NHS. Sharing resources for health in England - RAWP Report
  • 1977 NHS Act. Resource Allocation Working Party (RAWP) starts allocation of RHA funds proportional to measured need, State Hospital Carstairs: Report of public local inquiry into circumstances surrounding the escape of two patients on Nov 30, 1976 - Carstairs Report
  • 1979 New consultant contract. Royal Commission on the National Health Service. Patients First recommends abolution AHA and districts replacing with single tier District Health Authorities (DHA). Acute hospital services in London London Health Planning Consortium commences major London reorganisation.
  • 1980 Inequalities in health: report of a research working group - Black report
  • 1982 Abolition of AHAs and restructed DHAs. First report of the Steering Group on Health Services Information - Körner Report. United Kingdom Central Council for Nursing, Midwifery and Health Visiting established
  • 1983 Mental Health Act. Competitive tendering for ancilliary services
  • 1984 General managers first appointed. National Health Service management inquiry report. - Griffiths report, Report of the Committee of Inquiry into human fertilisation and embryology - Warnock Report
  • 1985 Project 2000 changes of nursing education
  • 1986 Crown immunity from the NHS in respect of food and health and safety legislation removed. NHS Management Board established. Neighbourhood nursing: a focus for care. - Cumberlege Report
  • 1987 Health Services in London – a Strategic Review -The Turnberg review. Promoting better health, the government’s proposals for improving primary health care Access to Medical Reports Act.
  • 1988 Department of Health and the Department of Social Security split. Charges for eye tests and dental check-ups. Public Health in England: the report of the Committee of Inquiry into the Future Development of the Public Health Function. - Acheson Report, Guidelines for the safe and secure handling of medicines: a report to the Secretary of State for Social Services. - Duthie Report
  • 1989 NHS Management Board split into the NHS Policy Board and the NHS Management Executive. Working for patients - creation of Internal market, Children Act
  • 1990 National Health Service and Community Care Act creates purchaser provider split with NHS Trusts as secondary care providers. GPs contract, Statement of fees and allowances payable to general medical practitioners in England and Wales from 1 April 1990. - Red book
  • 1991 Purchaser/provider split. General practice Fund Holding established, Junior doctors: the new deal - Calman Report, Patterns of hospital medical staffing - Dowie Reports
  • 1992 Report of the inquiry into London's health service, medical education and research - Tomlinson report
  • 1994 First wave Hospital Trusts, Confidential inquiry into homicides and suicides by mentally ill people - Boyd Report, Mental Health Nursing Review Team Working in partnership: a collaborative approach to care - Butterworth Report , Supporting research and development in the NHS: a report to the Minister of Health - Culyer Report
  • 1995 A policy framework for commissioning cancer services. - Calman-Hine Report
  • 1996 Reorganization of regional health authorities, FSHAs abolished
  • 1997 The new NHS - Modern, Dependable outlined new organisational structure and national supervisory bodies such as NICE Primary Care Groups (PCGs) established to replace fundholding, Report on the review of patient-identifiable information - Caldicott Committee Report
  • 1998 A First Class Service: Quality in the New NHS outlines Clinical Governance. GP Fundholding abolished
  • 1999 Devolution of power to Scotland and Wales. Health Act - quality a legal duty.
  • 2000 NHS Executive abolished. National Service Frameworks. The NHS Plan – a plan for investment, a plan for reform Primary Care Trusts (PCTs) to take on commissioning and major Hospital investment (via rebranded Private Finance Initiative). Community Health Councils (CHC) to be replaced by patient advocacy service (PALS). An organisation with a memory[3] published by the Chief Medical Officer noting the absence of learning from past NHS failures.
  • 2001 Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary, 1984-1995. - Kennedy Report
  • 2002 Regional reorganisation. "NHS foundation trusts" announced to commence in 2004
  • 2003 CHCs abolished
  • 2006 Reorganisation of Strategic Health Authorities and Primary Care Trusts, Payment by Results introduced
  • 2007 Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century
  • 2010 Equity and excellence: liberating the NHS announces that in England SHA's and PCT's to be abolished
  • 2012 In England the Health and Social Care Act 2012
  • 2013 Creation in England of NHS Commissioning Board and Clinical Commissioning Groups to replace SHA's and PCT's.

See also

References

  1. ↑ Godber G.Forty years of the NHS. Origins and early development. BMJ. 1988;297(6640):37-43.
  2. ↑ Gullick D. Forty years of the NHS. The act, the minister, and the editors. BMJ. 1988;297(6640):55-8.
  3. ↑ An organisation with a memory DoH 200
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