Creation of the Emergency Medical Service

The Emergency Hospital Service (later Emergency Medical Service) was established at the outbreak of World War II in 1939, giving central government a right of direction over voluntary and municipal hospitals. 

Preparing for war

The requirement to provide hospital care for civilian casualties of air raids led to the creation of the emergency hospital service. Preparations for the service were stepped up during 1938–39.

From June 1938, the Ministry of Health appointed regional hospital officers, supported by county and county borough medical officers of health to organise hospital services on a regional basis. The aim was to link casualty hospitals in danger areas to each other and to hospitals in outer areas.

County hospitals and large mental health hospitals, in particular, were taken over and new, temporary, hutted hospitals were built. All were subject to regulation around issues such as planning and manpower direction. For the first time, staff moved freely between the two different types of hospital, transferring knowledge and experience.

The Ministry of Health conducted surveys and inspections to try to understand the quantity of beds and quality of hospital provision nationally. The ministry lacked basic information on bed numbers, staffing, conditions and so on. The surveys highlighted widespread variation in standards and quality.

In April 1939, it was decided that the maximum number of beds that could be released to support air raid casualties would be 300,000. The 300,000 figure was significant but fell short of some of the earlier calculations that, by the fourth week of war, the total number of air raid casualties could reach 430,000.

Developing a hospital service

As part of the process of developing a hospital service, the ministry needed to:

• establish protective measures at hospitals, such as building shelters
• adapt and improve hospital buildings
• organise a centrally directed transport service
• organise an information service to collect and circulate information on admissions, bed numbers and deaths
• establish an emergency public health laboratory service, and expand and improve existing pathological laboratories
• organise a blood storage service.

Balancing population needs

One of the challenges for the service was to deal with the routine needs of a 'normal' population of sick people, while freeing up capacity to deal with war-related casualties. Initially, this balance was not ideal, and the routine sick suffered through being denied hospital treatment.

It took some months of negotiation before the government managed to convince the voluntary hospitals, in particular, to reallocate beds for routine cases.

The Ministry of Health had been paying for beds to remain empty in London. Reopening routine beds required a redistribution of staff and resources. There was considerable opposition to reopening beds among voluntary hospitals, but public pressure and negotiations on doctors' remuneration contributed to the reorganisation of services.

Paving the way for a National Health Service

The Ministry of Health technically had broad powers to issue direction to hospitals. However, in practice, it had to refrain from doing so, given the strong independence and competition between the voluntary hospitals. 

The service was a loose alliance of separate organisations, working together to deal with a national emergency, but paved the way for separate and competing institutions to come together as part of the National Health Service.