🏥 Hospitals
Bevan nationalised most hospitals, so they were run for the whole country and not as charities or by councils.
Advances in Medicine, Surgery and Public Health, 1920-48: The NHS » Beveridge and the National Health Service
What you'll learn this session
Study time: 30 minutes
Edexcel spec: Paper 2 Section B, Breadth study B2, Key topic 5
- Why William Beveridge's 1942 report mattered
- How Aneurin Bevan created the National Health Service, and why many doctors opposed it
- How the NHS changed public health
- How the five themes of medicine changed from c1848 to c1948
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Unlock This CourseHealth care before 1948
By 1940 medicine could do far more than in 1848, but paying for it was a problem. The National Insurance scheme of 1911 gave workers a panel doctor and sick pay, but it did not cover their wives and children. Many hospitals were charities or run by councils, and patients often had to pay. Poor families still put off calling the doctor because of the cost.
Key terms:
- Welfare state: a system in which the government helps people with health, work, housing and old age.
- National Health Service (NHS): the health service started in 1948, paid for by taxes and free when you use it.
- Nationalise: to take something into government ownership.
William Beveridge and the 1942 report
During the Second World War the government asked the economist William Beveridge to study how Britain could look after its people. His report, Social Insurance and Allied Services, came out in 1942. It named five "giants" standing in the way of progress: Want, Disease, Ignorance, Squalor and Idleness. To defeat Disease, Beveridge said Britain needed a comprehensive health service for everyone.
The report was hugely popular. Ordinary people had suffered bombing and rationing, and many wanted a better country after the war. The government did not act at once, but the idea of a health service for all was now in public debate.
Aneurin Bevan and the creation of the NHS
Labour won the general election of July 1945, and Clement Attlee became Prime Minister. He made Aneurin Bevan Minister of Health. Bevan, a former Welsh miner, was determined to turn Beveridge's idea into reality. The National Health Service Act was passed in 1946 and the NHS began on 5 July 1948.
🩺 Doctors and local services
Family doctors (GPs) stayed self-employed but were paid by the government. Councils ran ambulances, health visitors and vaccination.
Treatment was free to everyone when they used it, paid for from taxes and National Insurance.
Opposition from doctors
Many doctors, led by the British Medical Association, fought the plan. They feared becoming government employees who would lose their independence and be told how to work. Some also feared losing income from private patients. In early 1948 a large majority of doctors voted against joining.
Bevan solved this by compromise. GPs stayed self-employed and were paid a fee for each patient on their list. Hospital consultants could still treat some private patients. Enough doctors joined, and the NHS opened on time.
Why the NHS mattered for public health
- Care for all: for the first time everyone, including women and children, could see a doctor or go to hospital without paying.
- Prevention: councils offered vaccination and health visitors, so the NHS aimed to prevent illness and not only treat it.
- Fairness: care no longer depended on how much money a family had.
The NHS proved very popular and demand was huge, which made it cost far more than expected. In 1951 charges were brought in for glasses and false teeth, and Bevan resigned in protest. However, the idea of a health service free for all stayed.
Drawing it together: the five themes, c1848-c1948
- Treatment and the cause of illness: miasma gave way to germ theory (1861), Koch's germ hunting, Salvarsan 606 and then penicillin.
- Public health: the voluntary Act of 1848, the compulsory Act of 1875 and the Liberal reforms led to the NHS in 1948.
- Surgery: anaesthetics ended the pain, antiseptics and then aseptic methods cut infection, and blood transfusion and plastic surgery improved in war.
- Women in medicine: Elizabeth Garrett qualified in 1865, and the two world wars gave women more medical roles.
- War, science and technology: war speeded up surgery, transfusion and penicillin.
Change was often slow, and government had to step in before ideas helped everyone.
Common mistakes
- Saying Beveridge started the NHS. His report gave the idea; Bevan carried it out.
- Saying all doctors welcomed the NHS. Many opposed it.
- Writing about the NHS only. For a change-over-time question, cover the whole period.
Exam-style question
How far did public health provision change in the years 1848 to 1948? [16 marks]
You may use the following in your answer:
- The Public Health Act of 1875 (it made councils provide clean water and sewers)
- The National Health Service (it began on 5 July 1948)
You must also use information of your own.
Model answer
Public health provision changed a great deal between 1848 and 1948, but the biggest changes came late and some problems remained, so the change was large but not complete.
In 1848 provision was weak. The Public Health Act of that year was voluntary, so towns could ignore it, and many stayed dirty with cesspits and no sewers. After the Great Stink of 1858, Bazalgette built London's sewers. The Public Health Act of 1875 then made councils provide clean water, sewers and a medical officer. This was a major change because the government now forced action. Death rates fell, from about 22 per 1,000 in the early 1870s to about 18 by 1900.
The next big change was help for individuals. The Liberal governments of 1906 to 1911 brought in school meals, school medical inspections and National Insurance, which gave workers a panel doctor and sick pay. Before this, the government had rarely helped people directly. But insurance did not cover wives and children, so care was far from fair.
The NHS in 1948 was the largest change. Following Beveridge's report of 1942, Bevan created a service free to everyone, paid for by taxes. For the first time families did not have to pay to see a doctor, and councils ran vaccination and health visitors. This was a clear break from the past.
However, there was continuity. Bevan had to compromise with doctors, who opposed the plan, and GPs stayed self-employed. Poverty and ill health did not vanish, and the government's job of improving public health had grown only step by step from 1875.
Judged by who received help, public health changed enormously. In 1848 the government did almost nothing for most people, whereas by 1948 it guaranteed care for all. Because change came in stages and followed war and public pressure, it was dramatic by 1948 but slow before then.
What lifts this to the top level: it covers the whole period and several aspects (sewers, insurance, the NHS), uses facts beyond the bullets, weighs change against continuity, and reaches a judgement against a stated criterion, who received help.
Exam tip
In a "how far did X change" essay, give each stage its own paragraph, include one counter-point on continuity, and end by judging the extent of change against a criterion.