Born 70 years ago, the National Health Service was a major advance for the British people and especially for the nation’s health workers.
Before 1948, the cost of specialist and hospital care was beyond the means of a large proportion of Britain’s population.
That changed in July 1948 when a reforming Labour government established the National Health Service with care based on need and not the ability to pay.
The NHS was “free at the point of use” meaning anyone could go to a hospital or GP and not have to pay.
It remains a no-fee service today. As a result, only about 11 per cent of Britons buy health insurance, compared to about 45 per cent of Australians with private hospital cover.
Just as importantly, the NHS was a nationalised service, with the government taking over existing hospitals, laboratories, warehouses and laundries and building new ones.
Labour recognised that Britain needed a centrally funded service to replace a fragmented, inefficient and inequitable system with multiple providers, says James Buchan, professor at the School of Health Sciences in Edinburgh’s Queen Margaret University.
“The NHS was an early example of universal health care funded through general taxation, which even now is regarded as the most efficient way of funding a public health system,” he says.
“The vast majority of people living in the UK were born into the NHS. It has become part of the country’s DNA.”
Professor Buchan is also an Adjunct Professor at the University of Technology, Sydney, and a leading academic specialist on health workforces.
He says the NHS arguably leads the world in equitable access to health care including “very sophisticated, life-saving, life-prolonging” treatment.
Undermined by underfunding and privatisation
By comparison with other rich countries, it performs well in regards to long-term conditions like diabetes and kidney disease but is “below average” in outcomes for cancer, heart attack and stroke – mainly because of under-funding, he says.
“There has been a tendency particularly from Conservative governments to try to reduce funding relative to historic trends.
“It’s a very simple equation – the more you spend on health, the more resources the system has and the better it is able to respond to challenges.
“The United States is an exception – an example of huge funding of a grossly inefficient system.”
Like Australia’s public system, the NHS has suffered from privatisation but privatisation remains “on the margins” relative to Australia, Professor Buchan says.
“The NHS is now structured differently in each of the four UK countries – England, Scotland, Wales and Northern Ireland. In England, private providers such as Virgin Care have become prominent but in Scotland there is virtually no private involvement.
“That doesn’t mean there aren’t for-profit corporations waiting in the wings and trying to influence the political landscape to make it easier and financially more attractive for them to move in.”
Professor Buchan says that over the past decade or so, staff shortages and severe workloads have led to reduced retention rates and poorer care outcomes.
“England has 30-40,000 nursing vacancies – roughly a 10 per cent vacancy rate. Hospitals are scrambling to plug the gaps with agency staff, which is one way that money leaks out of the system.”
Many Australian nurses have trained and worked in the NHS and Professor Buchan says it is still one of the best training grounds for health professionals.
However, relatively fewer foreign nurses come to the UK these days.
Professor Buchan says reasons include a tougher English language test, increased cost of getting recognised to practice, the falling value of the pound and uncertainty over Brexit.
NHS still a huge employer
As a nationalised service, the NHS directly employed the vast majority of its staff from the outset. By 1961 it had become Britain’s largest organisation.
Doctors, dentists, nurses and midwives accounted for about 45 per cent of the total. The rest were employed in supplying and maintaining NHS facilities, or in administration, scientific and technical work.
Direct employment meant a single pay structure, so that the terms and conditions for a hospital cleaner became the same throughout Britain, with some allowances for local cost-of-living.
In the 1980s, the Conservative Party government of Margaret Thatcher began to contract out NHS ancillary services such as laundry, cleaning and catering to private firms through a process of “competitive tendering”.
By the end of the 1980s the number of NHS ancillary staff had almost halved.
After 2000, Tony Blair’s “New Labour” government continued the process of privatising services by contracting private companies to build hospitals and provide some clinical services.
Despite this, the NHS still employs about 1.1 million people. Almost all British hospital nurses, midwives and doctors continue to be employed by the NHS and work in NHS-run hospitals.
Have you worked in the NHS?
Nurses in Australia who have worked in Britain’s NHS are invited to share their experiences via a survey that will help create a “people’s history” of the service.
The survey offers NHS staff past and present the opportunity to anonymously record their experiences and views about life in the NHS.
Survey responses will feed into research for the history and also form part of a new archive collection that will contribute to future understanding of the NHS and its place in British life.
Coordinated by historians at the University of Warwick, the People’s History of the NHS centres on three online projects: a People’s Encylopaedia of the NHS, a Virtual NHS Museum and survey results and stories submitted by the public.
The survey can be accessed via https://peopleshistorynhs.org/worksurvey