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National Health Service Act 1946

The Labour victory in the general election brought a new minister of health – Aneurin Bevan – who rejected previous proposals for local authorities to take control of a national health service and argued that the variation in the quality and size of local authorities would worsen health inequalities.

The National Health Service Act 1946 received royal assent on 6 November 1946 and created a nationalised health service for England and Wales, a ‘remarkable experiment in health care’ (Webster, 2002). The act made provision for voluntary hospitals and hospitals in local authority control to transfer to the Minister of Health, although a small number of hospitals remained independent, such as the Royal Masonic Hospital, which only began accepting paying non-mason patients in 1977. A separate health system for Scotland was created by the National Health Service (Scotland) Act 1947. The act came into force on 5 July 1948 and provided for a health service that was comprehensive, free at the point of use and universally available to all.  

Key principles that are still echoed today included:

  • 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; the prevention, diagnosis and treatment of illness; and to 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).

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. Four hundred hospital management committees were responsible for administering hospitals. Teaching hospitals had differing arrangements and were managed by boards of governors
  • general practitioners (GPs) were independently contracted to provide primary care services and were paid for each person on their list. Executive councils were health service bodies who appointed GPs, administered contracts and salaries, and allocated patients, and
  • 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 (Gorsky et al., 2014). 

The act came into force on 5 July 1948. With the introduction of the NHS, the consultants and staff in the hospitals became salaried employees, while GPs insisted on remaining independent contractors – to which Bevan agreed. They had a contract for services, not a contract of service, and at a local level competed for patients, sometimes viciously.