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The history of the NHS, social care and public health policy

Explore all the significant developments in health and social care reform in England

Image of light bulbs appearing as footprints on a path leading to a lit light bulb indicating a new idea.

NHS reform

Providers of health care in the UK have taken many different forms since the eleventh century. In this theme, we explore the origins and development of the current provider landscape, focusing predominately on the development of our hospital infrastructure.

Adult social care

Adult social care today refers to a broad range of services and providers including residential care homes, nursing homes and supported living. This theme charts the emergence of formal social care services, the split between health and social care, and political failure to deliver a sustainable funding system.

Public health

Public health refers to measures to prevent disease, prolong life and promote the health of populations. In this theme, we cover the response to disease outbreaks, the introduction of public health services and campaigns, and England’s experience of environmental threats to health over time.

COVID-19 policy tracker

Our policy tracker provides a description and timeline of national policy and health system responses to COVID-19 in England since 31 December 2019. It includes data on what changes have been introduced, when, why, and by whom – as well as how these changes have been communicated by policymakers. We track policy changes in five areas – from health and care system changes to wider social and economic policy.

Johnson years (2019–2022)

23 July 2019

Boris Johnson named as prime minister

Following Theresa May’s resignation, Boris Johnson defeated Jeremy Hunt to become leader of the Conservative Party and prime minister of the UK.

26 September 2019

NHS recommendations to government and parliament for an NHS bill

NHS England set out proposals for a ‘highly targeted bill’, aiming to remove legislative barriers to integration and enable implementation of the Long Term Plan.

25 February 2020

Health equity in England: the Marmot review 10 years on

Professor Sir Michael Marmot examined progress in addressing health inequalities in England, 10 years on from the landmark Marmot review.

May years (2016–2019)

21 July 2016

Public Health England advice on Vitamin D

New advice from PHE recommended that everyone should have 10mcg of vitamin D per day to protect bone and joint health.

18 August 2016

Childhood obesity: a plan for action

The government released a national strategy to tackle childhood obesity – the first chapter came out in 2016.

1 September 2016

Public health post-2013 inquiry

A Health and Social Care Select Committee report described the impact of real term budget cuts to public health departments.

Cameron years (2015–2016)

1 June 2015

Improving GP services: commissioners and patient choice

Monitor reviewed how GP services worked for patients, focusing on the role of choice and competition.

4 June 2015

2015/16 public health budget cuts

George Osborne announced measures aimed at reducing public debt including £200m in cuts to the public health budget.

19 June 2015

New deal for general practice

The Secretary of State for Health, Jeremy Hunt, set out a number of commitments (both new and existing) in relation to general practice.

Coalition years (2010–2015)

20 May 2010

The Coalition: our programme for government

The new government set out its health and social care priorities: it promised a commission on adult social care funding but did not reflect the ensuing wide-scale NHS reforms.

30 June 2010

Changes to CQC's assessment of adult social care services

CQC announced they would no longer award quality ratings in inspections of registered adult social care providers. The move was met with concern.

12 July 2010

'Equity and excellence: liberating the NHS' white paper

The government set out plans for significant structural reform of the NHS, public health and social care systems.

Brown years (2007–2010)

1 July 2007

'A Framework for Action' review

Professor Sir Ara Darzi’s review of London's health set out the case for reforming services and proposed the introduction of polyclinics.

1 July 2007

Smoking ban in England

Smoking in enclosed public places was banned in England as a result of a long campaign beginning with studies in the 1950s, demonstrating the link between smoking and lung cancer.

11 October 2007

Investigation into C. Diff outbreaks at Maidstone and Tunbridge Wells NHS Trust

A report outlined findings following an investigation and highlighted several system failures that had led to the death of 60 patients from C. Diff.

Blair years (1997-2007)

May 1997

New Labour and the internal market in the NHS

The new Secretary of State for Health, Frank Dobson, confirmed the Labour party's manifesto commitment to abolish the internal market.

May 1997

The first Minister of Public Health

Having promised a new drive to improve public health in their manifesto, the Labour Party appointed the first Minister of Public Health.

8 December 1997

'The new NHS: modern, dependable' white paper

The new Labour government set out its intentions for NHS reform and announced programmes to improve public health.

Major years (1990–1997)

1 April 1991

The first NHS trusts

These trusts assumed responsibility for the ownership and management of hospitals, previously managed or provided by regional, district or special health authorities.

July 1991

The Citizen's Charter

The government launched the Citizen's Charter to redefine the relationship between citizens and public service, seeking to set out the rights and entitlements of patients.

July 1992

'The health of the Nation - a strategy for health in England' white paper

The paper outlined a health policy framework for the next 5 years and applied a strategic approach to population-wide health improvement.

Thatcher years (1979–1990)

4 May 1979

Margaret Thatcher becomes Prime Minister

Margaret Thatcher becomes Prime Minister, following an election manifesto suggesting the government would simplify and decentralise the health service to cut back bureaucracy.

8 July 1979

Merrison report

The Royal Commission on the National Health Service, chaired by Sir Alec Merrison, aimed to consider the best use and management of the financial and human resources in the NHS.


Encouragement of the privatisation of ancillary services

The government started to encourage the privatisation of ancillary services such as cleaning and laundry by sending a letter to health authorities encouraging them to tender contracts.

The early NHS (1948–1979)

5 July 1948

Establishment of the National Health Service

The NHS took control of 480,000 hospital beds in England and Wales, that had belonged to local authorities, or were independent voluntary hospitals.

31 March 1950

'Public Health in 1948: remarkable statistics' report

The Ministry of Health published a report examining health and mortality outcomes during the first months of the NHS.

30 September 1950

First UK report linking smoking to cancer

The work of Richard Doll and Tony Bradford Hill was instrumental in determining that most lung cancers were caused by cigarette smoking.

Historical context (pre-1948)


Early hospitals founded during the medieval period

It is traditionally thought that the first hospitals in England emerged following the Norman conquest.


Physicians and Surgeons Act 1511

Physicians made petitions for regulation in the 15th century, leading to the Physicians and Surgeons Act.


The College of Physicians of London

The College of Physicians of London (later Royal College of Physicians of London) was established by a Royal Charter from King Henry VIII.