History of the National Health Service
Under the National Insurance Act 1911, introduced by David Lloyd George, a small amount was deducted from weekly wages, to which were added contributions from the employer and the government.
Bertrand Dawson was commissioned in 1919 by Christopher Addison, the first British Minister of Health to produce a report on "schemes requisite for the systematised provision of such forms of medical and allied services as should, in the opinion of the Council, be available for the inhabitants of a given area".
Being a shrewd political operator, Bevan managed to push through the radical health care reform measure by dividing and cajoling the opposition, as well as by offering lucrative payment structures for consultants.
At a dinner in late 1955 or early 1956 to celebrate the publication of the Guillebaud Report into NHS costs Bevan remarked to Julian Tudor Hart "ultimately I had to stuff their mouths with gold" about his handling of the consultants.
[30] A 2019 report said that a study by the 'Centre for Health Economics' at the University of York found that between 2004/05 and 2016/17 the productivity of the NHS increased nearly two and a half times as quickly as the larger economy.
[42] Nurses are the largest single group of professionally qualified staff in the NHS, with 306,000 employed in English hospitals and community health services as at December 2020.
[43] The NHS has long had one of Britain's most varied workforces, with employees from a diverse range of backgrounds in terms of class, occupation, gender, race and nationality.
[44] Men constituted a significant minority of nurses but were largely concentrated in mental hospitals, where their role historically had been more associated with manual labour, particularly the physical control of the patients.
[46] Consequently, under conditions of full employment in the 1950s and 1960s the NHS experienced regular recruitment crises in virtually all categories of staff, particularly doctors and nurses in some peripheral provincial areas.
Nurse training also had a very high drop out rate, in part related to students leaving to get married (in addition to rejection by some of the strict discipline imposed on them).
In 1967, the service employed 31,000 professional and technical staff connected with diagnosis and treatment, including audiologists, biochemists, dietitians, more than 9000 laboratory technicians, occupational therapists, physicists, physiotherapists, psychologists and radiographers.
The Thatcher Government encouraged (and eventually forced) health authorities to put most ancillary services out for competitive tender, effectively outsourcing the jobs of those workers.
Doctors expressed this opposition through their largest professional organisation, the British Medical Association, which held a number of ballots canvassing its members' (largely negative) opinions on arrangements for the new service.
Outraged students at St Mary's Hospital, Plaistow, Essex, organised a protest rally and a march, threatening to resign en masse if their demands for better pay, shorter hours and general improvements in conditions weren't met.
With the exception of an overtime ban and work-to-rule by administrative staff in 1957, organised by NALGO, and a go-slow by laundry workers in Carshalton in 1950, the NHS had little formal workplace conflict.
A combination of cautious organisations, staff who often saw their work as a vocation, and the domineering influence of doctors over the rest of the workforce, led to an "old colonial" system of industrial relations, structured largely by personal patronage and paternalism.
[51] In December 1972, ancillary staff, the worst paid and most marginalised section of the workforce, organised mass demonstrations across the country with around 150,000 workers and supporters protesting poverty level wages.
[46] In the years to come other groups took action over similar issues, with nurses mounting a sustained campaign over pay in 1974 and radiographers following suit in 1975 under the slogan "no raise, no rays".
The NHS saw a significant expansion in the number of workplace representatives in this period, sometimes forcing managers to consider the views of sections of the workforce, like the ancillary staff, who they had long ignored.
[46] By the end of the 1970s, industrial relations in the NHS were widely considered to be in crisis, with poor management and inadequate personnel procedures causing endemic conflict in a substantial minority of hospitals.
Following the 1983 Griffiths Report, the NHS also tried to import a business model more similar to the private sector with professional managers taking over cost control, reducing the power of the medical profession.
A King's Fund study of OECD data from 21 nations, revealed that the NHS has among the lowest numbers of doctors, nurses and hospital beds per capita in the western world.
Hospitals and GP practices, in particular, have been repeatedly dramatised as locations that lend themselves to displaying wider life stories – love, birth, ageing, dying, friendships and feuds.
During the Second World War, film grew in popularity as a way for the British government to keep citizens informed, impart advice and help raise morale on the Home Front.
[67] Here's Health instead employed the narrative techniques of melodrama to dramatise one family's response to a household accident and the sudden need for medical attention during the Christmas of 1947.
[71] At a time when controversy over the NHS was high on the public agenda, Paul Unwin and Jeremy Brock began their proposal for Casualty by declaring that 'In 1948 a dream was born: a National Health Service.
'[71] This politicised agenda remained in evidence during the first three series of Casualty, with the programme showing how those who fictionally worked for the NHS were also dissatisfied with the new direction of the service.
'[75] Analysing cartoons about health featured in Punch magazine from 1948, the psychiatrist Bernard Zeitlyn argues that they 'centred on the bonanza of free spectacles, beards and trips abroad' that the NHS would bring.
In one such example, from January 1949, cartoonist Joseph Lee showed an irate man chasing a child, asking, 'Who's been practising Home Perms on my free National Health Service wig?
In December 1960, cartoonist Victor Weisz drew an image for the Evening Standard showing Minister for Health Enoch Powell as a surgeon covered in blood, accusing him of making too many cuts.
