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Sarah Itam, urological surgeon.  Fellow at University College Hospital, London

In the first two decades of the 2000s the NHS has been kicked around as a political football, and dogged by underfunding, strikes and scandals. But never before has it been so championed and beloved by the British people.

Today the vast majority of those living in the UK are no longer able to remember a time before the existence of the NHS.  

The first baby born into the NHS, at one minute past midnight on 5 July 1948, is now 70 years old. Born in a cottage hospital in Glanamman, Carmarthenshire, Aneira Thomas was named in tribute to the health service’s founder, Aneurin Bevan, and her parents were saved the one shilling and sixpence fee for the midwife.  

“My mother would introduce me as Nye, her National Health baby,” recalled Aneira later. “Up until the age of nine or ten, I really thought Aneurin Bevan was my father.”

Over her lifetime, Aneira has seen remarkable advances in medical technology and treatment. In 1953, when both Aneira and the National Health Service were four years old, there was a major breakthrough when the structure of DNA was revealed for the first time by James Watson and Francis Crick; in 1958, polio and diphtheria vaccinations were made available to all children under the age of 15; abortion was made legal in 1968 when Aneira was 19; the first heart transplant took place later that year. She has seen the first test-tube baby born in 1978, the introduction of keyhole surgery in 1980 and the launch of the organ donor register in 1994.

Keyhole surgery, as depicted in this sketch of an operating room, was introduced in 1980 and is now regularly performed by NHS surgeons.

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A surgical operation to reconstruct a patient's anterior cruciate ligament

Aneira, like her four sisters, went on to work as a nurse, and ten years ago – aged 60 – she gave a speech at the Labour Party conference to celebrate the health service’s anniversary. She was “proud to be a little part of history”, she told delegates. She was certain, she added, that if her namesake could see how far the NHS had come, he would be extremely proud too.

But it hasn’t all been smooth sailing, and never more so than in the last decade. Between 1998 and 2010 spending on the health service more than doubled in real terms, increasing at a rate of over 6 per cent a year; after the financial crisis of 2008, however, there has been a return to relative austerity following this time of plenty. While spending has continued to grow, it has increased by only 1.4 per cent a year.

Around the same time, a scandal in patient care came to light when the Mid Staffordshire NHS Foundation Trust was investigated over unexplained levels of patient mortality. There, it was estimated that between 400 and 1,200 patients had died due to poor care in the trust between 2005 and 2009, and a later inquiry laid the blame upon a failure of leadership, cost-cutting and a “chronic shortage of staff, particularly nursing staff.” Several nurses were disciplined.

That initial estimate, which was based on projections, has been hotly disputed, but subsequent inquiries reported a litany of failings and cases of neglect: misdiagnoses; dirty wards; patients left unwashed, unfed and unable to use the toilet. The scandal had a serious effect on public trust, and the name ‘Mid Staffs’ has since become synonymous with state healthcare at its very worst.

Nevertheless, when it came for Britain to host the Olympics in 2012, the NHS would take centre stage. Danny Boyle’s riotous opening ceremony featured many iconic figures from British culture – not least the Queen ‘parachuting’ into the stadium with James Bond, Rowan Atkinson as Mr Bean, and a cameo by Tim Berners-Lee, inventor of the World Wide Web – plus a two-minute long tribute to Great Ormond Street Hospital and the National Health Service, featuring 1,800 dancing volunteers dressed as mid-century nurses (including 600 real-life nurses) and pyjama-clad children bouncing on hospital beds.

Danny Boyle paid tribute to the NHS and GOSH at the 2012 London Olympics Opening Ceremony. 

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London 2012 Olympic Opening Ceremony - NHS Section

The ceremony was watched by an estimated 900 million across the globe – thus serving as a synecdoche of how Britain would like to present itself to the world. While prompting jubilation at home, the NHS segment provoked some bemusement overseas, where health services – state or otherwise – are not viewed with the same collective affection. As one “baffled” American journalist noted, it was “like a tribute to United Health Care or something”. One Russian commentator declared it “incomprehensible to non-Britains”.

But Boyle was unapologetic. “Everyone is aware of how important the NHS is to everybody in the country,” he declared to the press. “One of the core values of this society is that it doesn’t matter who you are, you will get treated the same in terms of health care.”

The last time the UK had played host to the Olympics, in the summer of 1948, the NHS was only three weeks old. Much had changed – not least this new passion for the state-run health system.  

It was visible again in 2016, as junior doctors once more returned to their picket lines – this time making their first all-out strike in history, with consultants manning the emergency wards. It became clear then that the conversation had shifted significantly from that of the 1970s: though the flashpoint was still the issue of pay and working hours, doctors now framed their argument as a defence of the service as a whole. The British Medical Association – the doctors’ trade union – declared that the new contracts were “an existential danger to the NHS”. Even those who worked for the NHS, while bearing serious grievances, now avoided questioning its values.

The NHS was invoked again as political ballast during the run-up to the EU referendum in 2016, infamously appearing on the side of a pro-Brexit bus that called for £350 million of the funds allocated to the EU to be directed instead to the health service – a proposal that was soon watered down. What’s clear is that to invoke a risk to the beloved NHS is a powerful way in which to mobilise public sentiment.

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Faces of the NHS: 2000s & 2010s

Now, in 2018, the newspapers are again full of warnings of an NHS in crisis – of record demands, bed shortages and mounting debts.  Still, says historian Jane Hand, a research fellow for the Cultural History of the NHS project, “there has always been a sense of the NHS being in crisis, and today is no different. To an extent, it is in times when the NHS is in crisis that we see the public really rally around it.” 

The NHS has weathered a great many storms already over the past seven  decades, and there will be plenty more to come. But its place in British hearts has never been more secure.

Cal Flyn is a writer and reporter from the Highlands of Scotland. She writes across the British press, including the Guardian, the Sunday Times, the Daily Telegraph, Prospect and New Statesman. Her first book, ‘Thicker Than Water’, was published by William Collins in 2016, and selected by the Times as one of the best books of that year.

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Cal Flyn

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Sarah Itam, urological surgeon. University College Hospital, London

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Despite underfunding, strikes and scandals, the first two decades of the 2000s has seen the British people’s love of and loyalty to the NHS soar.

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This six-part series explores the immense significance of the NHS to the British people. From its conception in the 1940s to the unprecedented pressures it faces today, Cal Flyn documents critical moments in the organisation’s history.

The birth of Britain's National Health Service

Fees, funding and the NHS

Medics, migration and the NHS

NHS strikes and the decade of discontent

NHS Blue: the colour of universal healthcare

Born in the NHS

This six-part series explores the immense significance of the NHS to the British people. From its founding in July 1948, to the unprecedented pressures it faces today, Cal Flyn documents critical moments in the organisation’s history.  

The History of the NHS

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Mandy English, paramedic. Hull East Ambulance Station, Hull

When wholesale privatisation of the NHS proved unacceptable to the British public, the Thatcher government instead introduced the ‘internal market’ in the 1980s. The resultant scattering of disparate parts of the service then prompted the need for reunification under a corporate brand in the 1990s.

The arrival of Margaret Thatcher’s government in 1979 – in the wake of the Winter of Discontent, when ambulance drivers had been among those protesting in the streets – made for an abrupt change in political attitudes towards the NHS.  

The Thatcher administration’s privatisation efforts saw the sell-off of council housing stock, and the floatation of British Telecom and British Gas, among others, during the 1980s. But when the government turned its attention to the National Health Service, the force of popular opinion was such that the suggestion of privatisation had to be immediately dropped – and the attempt denied.  

Years later, while writing his memoirs, the former Chancellor Nigel Lawson would famously comment: “The NHS is the closest thing the English now have to a religion.” Lawson was expressing retrospective frustration over the furore caused by his government’s abortive attempt to restructure health provision – the first serious demonstration of how deeply the NHS had become embedded in the national consciousness.

Different arms of the NHS began to ‘brand’ themselves – leading to unique looks such as the mixture of fonts used for the Wakefield and Pontefract Community Health logo.

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Wakefield and Pontefract Community Health Logo

The trouble began when the Central Policy Review Staff – a government think tank – was asked to reimagine the welfare state in 1982. Among the ideas put forward were proposals to charge for state education and to replace the NHS with an insurance-based service. This would, the paper noted, “mean the end of the National Health Service”. It would be “controversial”, it added.

So it was. When presented to ministers, the report caused “the nearest thing to a Cabinet riot in the history of the Thatcher administration”, Lawson recalled. Outrage was such that a section of the report was leaked to the press, causing public outcry – and Thatcher was forced to reassure the country of her continued fidelity at that year’s Conservative conference. “Of course we welcome the growth of private health insurance,” she told delegates. “…But let me make one thing absolutely clear. The National Health Service is safe with us.”

But Thatcher made no secret of her preference for private insurance: the following year, 1983, she was admitted to a private hospital in Windsor to repair the retina in her right eye – paid for by Bupa. (Catering at the hospital was provided by the same firm that supplied the royal family at nearby Windsor Castle.) Three years later, when she returned to hospital for an operation on her hand, the Observer would note that by again going private she had avoided a four-year waiting list in the NHS.

Still, however politically unworkable the break-up of the NHS had proven, some reforms brought in by the Thatcher government would continue long after she had been toppled.

The photographer Alex Liivet noticed the unusual styling of this sign: “This is intriguing, design-wise. It’s using the old NHS signage font (Rail Alphabet) but in a revamped, late 1990s layout and colour scheme. It’s as if somebody didn't get the full memo...”

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Mixed branding

The first step in the corporatisation of the health service was the introduction of a layer of professional managers, as recommended by Sir Roy Griffith, managing director of a supermarket chain. Then a number of non-core services – such as catering and laundry – were franchised out.  

“Privatisation was a very big theme of the time, but although some services were now being privately run and delivered, they were still paid for by the state,” explains historian Mathew Thomson, Joint Director of the People’s History of the NHS project. “The key issue of the service being free when you receive it was not touched. It matters, the public disquiet over something like that.”

But by 1987 many health authorities were in debt and waiting lists were growing, despite an increase in expenditure. Thatcher commissioned a fresh review: one that would lead to the most radical reforms in NHS history. The result, the ‘Working for Patients’ white paper in 1989, paved the way for the introduction of a so-called ‘internal market’ – a model in which some arms of the NHS (health authorities and GP surgeries) would ‘purchase’ care from NHS ‘providers’, like hospitals and ambulance services.  

While this system was billed as bringing better value for money, it also had the potential to increase variation in care and regional inequalities. After devolution in 1998, Wales and Scotland both elected to do away with the internal market system, reflecting the different political climates over the borders. (The health service in Northern Ireland has another name entirely: Health and Social Care, or HSC.)

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Faces of the NHS: 1980s and 1990s

Until this point, a monolithic bureaucracy ran all aspects of the health service. But after the internal market was established the organisation became increasingly fragmented and its identity more diffuse. New Labour came to power in 1997, elected with a promise to do away with the internal market system, but this plan was soon abandoned. Different arms of the NHS, in competition with one another, took further  inspiration from the private sphere and began to ‘brand’ themselves – leading to a profusion of logos – more than 600 at one point, according to one estimate.

Today, most NHS hospitals have uniform styles of signage and feature the NHS logo prominently.

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NHS NNUH entrance

As a result, a logo was devised under which the many sections of the NHS would be united: the ‘blue lozenge’ in Pantone 300 – a shade now known as ‘NHS blue’. Today the logo, colour and even font (Frutiger Bold Italic, in white) are instantly recognisable.  

Though at first glance the rebranding of the NHS may seem like a superficial exercise, it marks an interesting stage in the organisation’s evolution in the public imagination. Back in 1948, the NHS had not been built from the ground up, but rather inherited a great many hospitals with pre-existing buildings and characters familiar to their local populations; this meant that despite the political fanfare, reaction to the new health service had been relatively muted – to the casual hospital visitor, little had changed. It had been “a kind of challenge of the imagination”, Thomson explains.

NHS England provide a style guide, including logo vectors, to ensure that the service is presented properly.

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NHS logo

The new visual language created in the 1990s – by which each disparate element could be clearly labelled as part of a greater whole – therefore played a big role in cementing the idea of the NHS as a single conceptual entity. “Whether intentionally or not, that brand exercise was useful in giving the NHS a much stronger identity,” adds Thomson.  

During the same period, we see this echoed in the way the NHS is discussed in the press: in the early decades, it is regularly referred to more generally as the ‘health system’ or similar terms; only in the 1990s does the use of the terms ‘National Health Service’ and ‘NHS’ shoot up. Thomson explains, “And it’s not just use of the name, but the preoccupation with it that has leapt exponentially across this period. That’s an important part of the story.”

Today the NHS polices the use of this brand – its colours, fonts and logos – very carefully, and views it as a key way of maintaining awareness of and public confidence in state healthcare. Research has found the brand to be instantly recognisable to 98 per cent of people, and that it evokes high levels of trust, reassurance and pride. Truly, the NHS has come to be seen as something greater than the sum of its parts.

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The 1980s and 1990s saw ideas from the world of business infiltrating the NHS, including the introduction of an internal market, followed by a corporate branding exercise.

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Dr Shiv Pande, general practitioner. Outside his former practice, Liverpool

The social unrest that characterised the UK of the 1970s perhaps inevitably affected its largest employer, the NHS. The established order in the service was disrupted by a wave of strikes initiated by every echelon of staff, generating reassessment and change.

Industrial action of any kind was rare in the NHS until the early 1970s. But as the new decade dawned, tensions that had been building over a period of years finally came to a head – in tandem with increasing social unrest across the country. A series of strikes affecting every level of the NHS took place. These challenged the assumptions that formed the very basis of the service and prompted re-evaluation of the roles played by support staff, and women more generally.

“It [the NHS] had been a sort of dictatorship of the doctors,” explains historian Jack Saunders, Research Fellow with the People’s History of the NHS project. “Its hierarchical nature – the sense that you shouldn’t question those with expertise – meant that employees hadn’t tended to think in confrontational terms. But anger over pay, and growing unionisation, made people in the NHS become more aware of collective movement.”

Workers in the health service have traditionally been reluctant to withdraw their services, for understandable reasons. Could patients’ lives be put at risk by their actions? Strike organisers therefore had to make careful strategic decisions to mount ethical but effective campaigns – causing logistical or administrative nightmares without interfering with acute and emergency care.

Ancillary workers went on strike after being passed over for a pay rise.

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National NHS ancillary workers demonstrations 13th December 1972

Of all jobs in the NHS, it was the ancillary roles (porters, laundry workers, catering staff and so on) that were the most poorly remunerated. Successive government reports had found these positions to be among the worst-paid jobs in the country. “The Service has for a long time been able to get by on the goodwill of its employees,” the Department of Employment warned in 1972.

And goodwill was wearing thin. Rising inflation meant already low salaries weren’t going so far. Then when local government staff received a pay rise while NHS workers were passed over, for many it was a bridge too far. Unions agreed a campaign of selective strikes, overtime bans and ‘working to rule’ (doing no more than the minimum specified on their contract), in an action that lasted six weeks and affected 300 hospitals. Although the strikes did not win immediate concessions, they constituted a watershed moment within the NHS. Ancillary workers had proved they were intrinsic to the function of the NHS – and without them, wards and even hospitals would close.  

As Jonathan Neale, a hospital porter in London and a steward with the National Union of Public Employees (NUPE), recalled, “The strike itself was no great victory, but it changed the way workers felt. At the end of the strike… The cleaner who hadn’t had a mop in three years got one. The porters got a fridge in their restroom. Now, nobody could be fired out of hand because their face didn’t fit.”

Nurses were next to strike: they received a great deal of sympathy from the public and the pay rise they had requested.

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When nurses fought back

The decision to strike was a particularly anguished one among nurses, who prided themselves on their values of self-sacrifice, patience and kindness, synonymous with the job since the days of Florence Nightingale.  

They were also a very disparate group, divided along the lines of rank, gender and class. Psychiatric nurses, for example, had traditionally been male – assisting in the restraint of difficult patients – and considered themselves manual workers, while elsewhere the position was becoming increasingly professionalised.

State-registered nurses, the most prestigious group, tended to join the Royal College of Nursing, and they were constitutionally barred from striking. But those belonging to other unions were free to do so – and in 1974, they did. “It was an awkward kind of strike,” explains Saunders. “There was a constant dialogue about what nursing was and what sort of knowledge it required. Was it a menial role – a doctor’s handmaiden – or a profession in its own right, with a deep skill base? In a sense it was a debate over how women’s work should be valued.”

The nurses’ calls were sympathetically received by the public: they received a million letters of support, and in 1974 a parliamentary committee awarded pay increases of an average 30 per cent. Later, a new class of specialist nurses would also be introduced, expanding the scope for advancement.

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Faces of the NHS: 1970s

One of the arguments made by striking medics was that healthcare should be valued more than nuclear weapons.

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Protestors with poster about Trident and NHS

The next dispute was very different: as much an internal fight between classes of staff as it was a row with the government. Since the establishment of the health service, consultants had been allowed to maintain a number of private patients on NHS premises – a lucrative source of income and one of the key concessions won from Aneurin Bevan in 1948.  

But now the newly empowered nurses and ancillary staff complained that these private patients increased their own workload – without bringing a fair share of the rewards. Workers began to boycott these private patients, including a group at Charing Cross Hospital in London led by the “battling granny”, Esther Brookstone, then Branch Secretary of the NUPE.

The quarrel between consultants and lower-status staff was the latest development in a broader disagreement of principle: should wealthy patients be allowed to jump the queue? The Labour government had pledged the abolishment of these ‘pay beds’, but when health secretary Barbara Castle announced plans to do so she faced stiff resistance, culminating in the consultants suspending all ‘goodwill activities’ between January and April of 1975. The action was called off when Castle relented, allowing part-time consultants to continue private practice; her plan to phase out private beds over a period of years also had only limited success before Margaret Thatcher’s election victory in 1979 brought it to an abrupt end.  

What became clear was that senior doctors still kept a very tight hold on the running of the NHS, and they would continue to do so until the 1980s.

When the doctors returned to work in January 1976, theirs would not be the last strike to take place in the NHS, but it did draw to a close the most conflictual period in the NHS’s history – when the workforce, particularly those in the lower ranks, felt their collective strength for the first time. They, too, questioned the assumption that NHS staff simply would not challenge their employer, reflecting a power shift across the UK as a whole, as workers demanded greater rights than ever before.

In 2016, junior doctors were on strike once more.

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Part of a junior doctors strike picket outside Norfolk and Norwich University Hospital

Junior doctors – that is, doctors who were qualified but yet to attain the status of consultant or GP – were in a somewhat less powerful position. Prior to 1975, they worked an average of 85.6 hours a week, during around half of which they were on call. Under new plans, it was proposed that their overtime pay would be cut by two thirds.

In response, junior doctors mounted actions across the country over several months – including strikes and walkouts – until the government found a further £2.3 million to fund the overtime. One of the ringleaders was Dr Wasily Sakalo, who argued that his sister, who had qualified only one year before in Australia, was earning double what he was after seven years: “It made me determined to try to obtain the same work conditions for British doctors,” he said.  

His words echoed the doctors’ increasingly international outlook – and raised the possibility of a ‘medical brain drain’, a spectre that would be raised again in 2016, when junior doctors were again on strike.

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When the social unrest of the 1970s spread to the NHS, dissatisfied staff challenged the status quo for the first time in quarter of a century.

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Cecilia Brown, nurse. St. George's University Hospital, London

Mass migration from Britain’s former colonies was a huge boon to the NHS, which by the 1960s had become the country’s biggest employer. But these thousands of much-needed medical staff faced widespread racism to build lives and careers in their new home.

The advent of the NHS coincided with another major change in British society: the mass movement to the UK of people from its former colonies. This influx of migrant workers – much-required during a time of staff shortages – would force the country to face its prejudices, and the increasingly multicultural NHS workforce would include some of the most visible ambassadors of this social change.

In 1948, the British Nationality Act awarded citizenship and full rights of entry to those living in Commonwealth countries. That June, as the government made its frantic preparations to take over the nation’s hospitals, the HMT Empire Windrush docked in London, carrying hundreds of passengers from the West Indies intending to start a new life in the UK. The ship’s arrival marked the symbolic starting point of postwar mass immigration, as the ‘mother country’ attracted large numbers of workers and their families from outside Europe for the first time.

The film ‘Enrolled Nurse’ aimed to attract people to train as nurses. It showed women of different ethnicities enjoying their training together. 

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Enrolled nurse

Many of them were attracted by official recruitment drives by British government bodies, which were desperately seeking skilled workers and willing trainees in a time of full employment. Unemployment had hit a postwar low of 1 per cent in 1955, or 215,800 people, and between 1950 and 1973 it averaged 2 per cent: good news for workers, but harder for their employers.  

The NHS, which became Britain’s biggest employer in 1961, engaged thousands of Commonwealth workers: by 1968, nearly half of all hospital doctors below the rank of consultant came from abroad, while around a third of student nurse and midwife roles were filled by Commonwealth migrants, many of them from the Caribbean. But though these new arrivals were welcomed by politicians and press alike, the response from the British public was more mixed.

The film ‘Day Out, Day In’ from the Department of Health depicted the diversity of the NHS workforce without remarking upon it or exploring any of the challenges that immigrant staff might face in the course of their working day.

In 1965, Cynthia Stuart travelled to the UK from Belize (then still known as British Honduras) to study nursing in Southampton. She was 19 years old. “I was focused,“ she recalls now. “I wasn’t coming to mess about.” Still, it was a long way from home: “The Home Sister took me to my room… and when she left, I looked out the window and thought: ‘What have I done?’ I remember putting my head on the windowsill and I bellowed like a cow.”

Cynthia was one of three student nurses of colour. And although her classmates were generally friendly and curious, there were occasions when she sensed wariness. “Nobody pushed me or spat in my face or called me a n***** or anything like that,” she says firmly. “In Southampton it was subtle.” When she met her colleagues in town, often they would cross the road to avoid her. “Now and again, someone in their dotage would say: ‘I don’t want any darkies to attend to me.’ But the Ward Sister would come up and say, ‘Now, now, we’re not having any of that,’ and we just got on with it! Sisters were sisters in those days.”

She didn’t let it trouble her, she says. “We had to take into account that we, people of colour, were new to people.” Cynthia excelled in her training, went on to qualify as a midwife and later lectured in midwifery during a 47-year career. Her dedication and positive outlook allowed her to thrive in her adopted country – even as British society was struggling to come to terms with its changing demographic.

Staff who had come from overseas performed a variety of roles for the NHS, such as nursing and dispensing medicine.

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Day out, day in

One public figure who was growing increasingly vocal in his opposition to unchecked immigration from the Commonwealth was a Conservative MP called Enoch Powell. Powell – a brilliant Classical scholar and once the army’s youngest brigadier – had served as the Health Minister under Harold Macmillan in the early 1960s.  

During that period, he had launched a campaign to recruit doctors from overseas (and succeeded in attracting 18,000 from India and Pakistan), whom he had praised as “a useful and substantial reinforcement of the staffing of our hospitals”. And at the time Powell was still regarded as something of a liberal voice, ever since he had voiced a blistering attack on the Kenyan colonial ministers in 1959.

But in the years to follow, Powell would become increasingly fixated upon the perceived perils of unchecked immigration. In April 1968, when he stood to address the Conservative Association in Birmingham, he would make the most infamous speech in British history, decrying the influx of migrants and warning that in time “the black man will have the whip hand over the white man”.  

The Times denounced his ‘Rivers of Blood’ tirade as “evil”, and he was sacked from the Shadow Cabinet the following day. But Powell’s words reflected an ugly mood in the country: shortly afterwards, a Gallup poll showed that 74 per cent of those asked had agreed with him; the following year the same pollster declared Powell the public’s “most admired person”.

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Faces of the NHS: 1960s

By 1969, the staff shortages in the NHS had begun to abate. 

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Doctors from overseas

In this climate, therefore, the behaviour of black and minority ethnic medical staff came under unusual scrutiny, and they would come to play a significant role in race relations in the UK.  

“The NHS was the first place in which many people in Britain came into contact with people of colour,” says Roberta Bivens, joint director of the People’s History project. “So to come into contact with someone who is professionally trained, who is helping you and instructing you and telling you what to do, stripping you naked and treating the part of you that is injured or ill… that’s an incredibly intimate relationship between clinical professionals and the patient.”

In the inflammatory public debate that raged across the newspaper pages, black NHS nurses and doctors found themselves invoked as symbols of the benevolence of immigration. “These people are the ones caring for you and yours, for your granddaughter, your wife, your husband who just had a heart attack,” adds Bivens. “How could anyone say they were burdens on our public services when they themselves were providing the public service?”  

Though racial tensions have reduced since the 1960s, unfortunately they have never completely gone away. Black and minority ethnic doctors are more likely to face patient complaints and to face fitness-to-practice investigations, for example, thought to be a symptom of continuing bias.  

But migrant workers have made a sizeable impact on the NHS, from the Windrush Generation nurses who ‘saved the NHS’ to the 25 per cent of foreign national doctors employed by the service today. Hundreds of thousands of people have come to the UK to work for our health service, and many of them have stayed to make it their home. Their compassion, diligence and dignity in the face of racism has played large part in their integration and acceptance into modern society.

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In the 1960s the NHS became Britain’s biggest employer. So to help fill all those jobs, the government brought in thousands of workers from abroad.

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Leslie Cheeseman, dentist. Guys Hospital, London

The launch of the NHS in 1948 had been a rousing success. But Aneurin Bevan’s promise that the NHS would be “free at the point of need” would, in the 1950s, be the root of the service’s first major crisis.

Reluctance from GPs and consultants had been overcome, a new administration had been put in place, and the general public had hurried to make use of their new health service. Many finally had the opportunity to visit a doctor or dentist for the first time in years, having previously abstained due to financial constraints. In its first year, the new NHS provided patients with 27,000 hearing aids, 164,000 surgical and medical appliances, 6.8 million dental treatments and 4.5m pairs of glasses.

But by 1950, there was a growing fear among politicians in both major parties that opting to make the service entirely free may have been overgenerous, and would lead to spiralling costs.  

It was true that initial spending had been far higher than forecast: in its first year, Bevan had to seek an extra £53m from the Treasury, nearly a third more than his original estimate. In March 1950, he would be forced to request a supplement of £100m, roughly half the entire education budget.  

Even before the NHS was established, satirists illustrated the fear that subsidised healthcare would drive up demand from people who were not really in need.

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A man sells a woman an artificial leg at national health service prices

Bevan argued that the spending was a necessary correction after years of war and inadequate healthcare, and that it would stabilise over the coming years (a prediction that was borne out in the 1950s), but the apparent profligacy in the NHS resulted in mounting dissension in the Cabinet, as other ministers felt their own budgets squeezed.  

Bevan’s biggest adversary was Hugh Gaitskell, an economist and a junior minister in the Treasury who was growing in influence in the Attlee government. Gaitskell pushed hard for NHS spending to be capped, and soon called for the introduction of charges for some aspects of the health service, partly to produce income and partly to stem demand.  

He and Bevan developed a deep personal animosity: both considered the issue of fees a matter of principle – Gaitskell for, Bevan against – and it became a proxy battle, a clash between representatives from either end of the Labour political spectrum.  

In 1950, this would all come to a head. The situation for the government was looking poor: it had a majority of just six seats, and in June the Korean War had broken out. After some hesitation – and exhausted by World War II –  the UK agreed to support the US in sending troops and in undertaking an expensive rearmament programme. Then, in October, the Chancellor, Richard Stafford Cripps, resigned through ill health. Gaitskell was promoted to replace him – and he immediately set about using his new powers to force the issue of fees.

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From the introduction of the NHS until 1975, people bought stamps to prove their National Insurance contributions and show their eligibility for the benefits of the new welfare state.

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National Health Service prescription stamps form

Stafford Cripps was not the only government figure suffering from poor health. The following March, the Prime Minister himself was admitted to hospital with a duodenal ulcer, a stress-related condition, and in his absence the acting leader Herbert Morrison unwisely allowed a Cabinet vote on fees.  

It approved Gaitskell’s plan to introduce charges for NHS spectacles and dentures, with the proceeds to go towards the defence programme.

All hell broke loose. Attlee’s hospital bedside, in the Lindo Wing of St Mary’s Hospital in Paddington, became a fitting backdrop to frantic meetings over the future of the health service.  

Despite pleas from doctors to spare Attlee worry, first Morrison arrived, then an outraged Bevan with his ally Harold Wilson, both of whom threatened to resign. Finally, Gaitskell himself arrived, also now threatening to resign if Attlee backed Bevan. Attlee, facing an impossible situation, would always maintain that had he not been in hospital, the whole farrago could have been avoided.  

Nevertheless, Gaitskell got his way and the introduction of charges was announced in his Budget the following day. “WILL MR BEVAN RESIGN?” thundered the Guardian. It added, in subheading, that the “controversy over NHS charges might bring down [the] government”. So it would prove.

Aneurin Bevan died in 1960. But the Labour Party returned to government under Harold Wilson four years after that. Wilson made the abolition of NHS charges a key election pledge, and kept to his promise once in power – but the economic downturn of 1967 soon forced him to back down and they were reintroduced in 1968, albeit with exemptions based on age, income and ill health.

Years later, following devolution, Wales, Northern Ireland and Scotland would end prescription charges for good – but in England they still exist, at £8.80 per item.

Spending did stabilise in the 1950s, as Bevan had predicted, and a committee chaired by the Cambridge economist Claude Guillebaud concluded that the service was efficient and cost-effective; if anything, Guillebaud said, it needed more money. So the Conservative government was put off restructuring it and rethinking the funding model.  

“People hadn’t all been cheering when the NHS first came into existence – there had been a bit of anxiety before it had arrived about it how it would work,” says George Gosling, a historian of medicine at Wolverhampton University. “But very quickly people settled into it. They got attached to the idea of being able to go to the doctor whenever you needed, for free – so there was a sense that people had come to like the new system, and didn’t want to lose it.”

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Faces of the NHS: 1950s

Nevertheless, the question of funding has never really gone away. NHS spending, though still lower per capita than in countries like the US, Switzerland, Germany and the Netherlands, has risen steeply since its earliest days – from 3.5 per cent of GDP in 1950/51 to 9.8 per cent of GDP in 2014, an increase of more than tenfold in real terms.  

Despite this, the health service today finds itself in a serious financial crisis. In 2018, NHS trusts are on course to run up a combined deficit of £5.9 billion, as an ageing population and long-term illnesses related to lifestyle puts them under unprecedented pressure. Diabetes is now thought to consume 10 per cent of the entire NHS budget of £116bn.

In the 1950s, dramatic political battles over NHS charges brought down a government. But public confidence in the service still grew.

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