The Guillebaud Report

The Committee of Enquiry into the Cost of the National Health Service

In February 1953, as the NHS approached its fifth anniversary, the Conservative government commissioned economist CW Guillebaud to chair a committee of enquiry into the cost of the National Health Service.

Based largely on the work of economists Brian Abel-Smith and Richard Titmuss (who later published their work in a memorandum The cost of the National Health Service in England and Wales in March 1956), the committee published its report in January 1956.

Findings of the committee

The committee had found that, in relative terms, the cost of the NHS was actually falling, and suggested that future increasing costs would be easily met through economic growth.

The committee noted that capital spending since 1948 had been around £12m a year, or roughly a third of the level it had been before the Second World War, and recommended this be increased to around £30m a year for the next 7 years.

The committee considered alternative models for the NHS, such as unifying the three branches of the service under generic health boards, transferring the hospital service to local authorities, or transferring executive council functions to regional hospital boards. Although it concluded that it was too early in the life of the NHS to conduct a radical restructure, it was, nevertheless, critical of the tripartite structure of the service.

This point was further emphasised in a note of reservation made by Sir John Maude, a former permanent secretary at the Ministry of Health and a member of the committee. He called for the unification of the service under local government control, echoing the original ambitions of Aneurin Bevan, saying that:

'A serious weakness of the present structure lies in the fact that the NHS is in three parts, is operated by three sets of bodies having no organic connection with each other and is financed by three methods one of which differs radically from the other two... some regard it as a major flaw in the scheme, others as no more than a piece of administrative untidiness.'