National Health Service Act 1946

The National Health Service Act 1946 received royal assent in November 1946. The Act provided for the establishment of a comprehensive health service for England and Wales, that was free at the point of use and universally available to all. 

Bevan's influence

The Act went further than had been anticipated in the 1944 white paper. In 1945, Labour had won the general election and Minister of Health, Aneurin Bevan, pushed for more radical reform. He favoured nationalisation of municipal and voluntary hospitals.

Aneurin Bevan also rejected previous proposals for the establishment of an NHS with local authorities having a key administrative role, arguing that the variation in the quality and size of local authorities would worsen health inequalities.

The new NHS was to be funded through income tax, with the rich paying proportionally more, while all users of the NHS were to receive the same level of service. This redistributed income, which was a major socialist objective expressed by Bevan.

Key principles

The key principles of the Act still echoed today include:

• A duty on the Minister of Health to promote the establishment in England and Wales of a comprehensive health service, designed to:
  • secure improvement in the physical and mental health of the people of England and Wales
  • secure the prevention, diagnosis and treatment of illness
  • provide or secure the effective provision of services in accordance with the Act/
• A commitment that services would be provided free at the point of use (with some exceptions).

A tripartite system

The newly formed National Health Service (NHS) was based on a tripartite system.

Hospital services were organised through 14 regional hospital boards, established across England and Wales. 400 hospital management committees were responsible for administering hospitals. Teaching hospitals had differing arrangements and were managed by boards of governors.

General practitioners were independently contracted to provide primary care services and paid for each person on their list. Executive councils were health service bodies that appointed GPs, administered contracts and salaries and allocated patients.

Local authorities continued to hold responsibility for community services, such as the provision of domiciliary midwifery and health visiting services, immunisations and public health functions. 

The NHS came into being on 5 July 1948, when the Act came into force. While prescriptions, spectacles and dentistry were originally free on the NHS, legislation brought in by Labour and Conservative governments in 1950 and 1952, resulted in the charging for these services respectively in response to the rising cost of the NHS.

This led, in part, to the resignation of Aneurin Bevan in opposition to these changes in 1951.

Other organisational bodies created by the act

The Central Health Services Council

The council included several standing advisory committees (SACs). Its role was to provide advice to the Minister of Health on health matters and respond to any questions submitted to it for advice. The SACs were usually focused on specific health service areas such as dental, pharmaceutical and nursing.

The membership was a mix of representatives from medicine, local government, lay people and professionals knowledgeable on specific areas of health such as mental illness. The council was abolished in 1980 by the Health Services Act 1980.

Executive councils

Executive councils were responsible for administering general medical services such as general practitioner, dental and pharmaceutical services, as well as 14 regional hospital boards which administered hospital services for large areas.

They managed 388 local hospital management committees (also created by the Act, with responsibility for managing the administration of NHS hospitals, excluding teaching hospitals) but were not involved in their day-to-day work due to their size and wider coverage.

The boards’ functions were largely focused on policy, directing and coordinating, and ensuring the effective distribution of resources. Executive councils, regional hospital boards, and hospital management committees were abolished in 1973 by the National Health Service Reorganisation Act.

The Public Health Laboratory Service (PHLS)

The PHLS provided microbiological investigation of communicable disease outbreaks, drinking water and food products. Fearing bacteriological warfare during the Second World War, the government had set up the Emergency PHLS to provide support to doctors and medical officers of health to identify bacterial strains.

Later, in 1977, the Communicable Disease Surveillance Centre (CDSC) was established and placed within the PHLS. One of the drivers of the CDSC's creation had been poor management of a number of outbreaks of disease, including the accidental release of smallpox into London in 1973.

It took over national surveillance and disease control functions from the Department of Health and Social Security in 1980.

In 1985, the Epidemiological Research Laboratory was combined with the CDSC. The CDSC was incorporated into the Health Protection Agency (HPA) in 2003.