Now 75 years old, the NHS remains, despite all its current ills, Britain’s most cherished post-war institution.
Creating it from scratch within just three years was a Herculean task. How this was achieved is not well known – mostly shrouded by the traditional civil service cloak of anonymity.
But Aneurin Bevan – the Labour minister who presided over the creation of the NHS – did shed some light on the process during the 1958 tenth anniversary debate in the Commons. He praised the work of permanent officials in London and Scotland, saying: “There are one or two people whom I can mention with propriety. One is Sir William Douglas, permanent secretary at the time, who, unfortunately, has died. The other is Sir Wilson Jameson, the chief medical officer, who, I am glad to say, is still very much alive and at work, although he has retired from the ministry.
“The nation was extremely fortunate in having two eminent civil servants of that calibre at the ministry at that time. I am quite certain that if hon. members and the nation generally knew how much work they did and what a huge task it was, they would feel very grateful indeed.”
That work started in July 1945 with Britain still at war with Japan. Bevan, the youngest member of the Cabinet, had the joint brief of housing and health. He quicky established good relationships with the two older officials – both Scots.
Douglas had an interesting career. After leaving Edinburgh University, he started in Customs and Excise, then moved to Paris for the plebiscite commission adjusting borders between East Prussia and Poland. He became secretary to the Department of Health for Scotland, and served with the Ministry of Labour, the Treasury, and the Ministry of Supply.
Douglas was Bevan’s choice for permanent secretary at Health – largely because of his wide experience.
Jameson, dean of the London School of Hygiene and Tropical Medicine (LSHTM), was a reluctant candidate for Chief Medical Officer in 1940, only persuaded to take the job out of duty by health minister Michael Macdonald (son of Ramsay).
In May 1941, Jameson became the first CMO to broadcast on BBC radio to promote the first national vaccination campaign against diphtheria.
At this time, London suffered from heavy air raids. Two medical colleagues in the health department were killed. Jameson’s home in Highgate was badly damaged by bombing. During the week he slept in an office at the LSHTM, but was fortunately away when it took a direct hit.
Douglas took refuge in the Athenaeum Club – a private members club in the centre of London – for informal discussions and to entertain visiting American doctors. He said it was the cheapest restaurant in London.
There was a strong chemistry between the three of them. Douglas and Jameson were very supportive to junior colleagues and left them to get on with details. Bevan was also content to trust his advisers.
By 1945, some sort of post-war health service was inevitable. It had been presaged by the 1942 Beveridge report. There was already an Emergency Hospital Service, set up to deal with anticipated air raid casualties at the start of war.
A lot of work had been carried out by civil servants in producing Sir Henry Willink’s white paper for the Wartime coalition government, though Bevan rejected this as a dog’s breakfast for not addressing key issues such as who would actually run the service.
His solution was simple – nationalise the whole network of voluntary and local authority hospitals. The service would be largely funded by general taxation and be free to everyone at the point of delivery. Women, children, and old people were the biggest beneficiaries – the existing national insurance scheme only covered employees, of which men formed the overwhelming majority.
Bevan wanted the NHS to offer the best of care – not just function as a poor safety net – and to be free at the point of delivery. Plans were made to meet huge anticipated demand for hearing aids, dentures and glasses.
Officials set about finding the best available commercial hearing aid which was copied and mass produced in a new factory. The hearing aid was evaluated by the Medical Research Council – hence it’s name: Medresco.
Bill drafting teams started work on the English and Scottish legislation. A bitter and protracted battle ensued with the British Medical Association.
Jameson was not comfortable acting as an intermediary, but he had the confidence of his minister and the BMA, having set up and served as the first secretary of its Finchley division in 1920.
The appointed day arrived on 5 July,1948 and the service got off a flying start, proving hugely popular with the public.
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Letter sent to health ministry workers by Nye Bevan before NHS was set up. Photo: World History Archive/Alamy
Dr John Marks, who would later become chair of the BMA, graduated on the day the NHS was founded. “There was a colossal amount of unmet need that just poured in,” he later noted. “There were women with prolapsed uteruses literally wobbling down below their legs. It was the same with hernias. You would have men walking around with trusses holding these colossal hernias in. They were like that because they couldn’t afford to have it done.”
The euphoria and optimism did not last. By 1951, Bevan resigned over the introduction of charges for dentures and spectacles. After his departure, the minister of health no longer had a seat at Cabinet. The NHS share of UK national spending fell from around 25 per cent to 20 per cent by 1963.
The agreement with hospital doctors resulted in salaried consultants and junior staff who were still able to carry out private work.
However, GPs remained independent contractors as did dentists and pharmacists. They were supposed to be the cornerstone of the NHS based on new health centres with GPs, district nurses, and health visitors offering prevention and promoting good health.
Instead, resources went into hospitals, in essence making it a National Treatment Service. Officials at the Department of Health in Edinburgh enthusiastically made plans for new health centres. It took five years for the first to be opened in Scotland and another twenty before the they became commonplace in the UK.
Research by Australian GP Joe Collings in 1950 found that general practice was already in a dismally poor state before the NHS placed huge additional burdens on it .
Jameson retired from the civil service in 1950 – describing himself as “an average boy” from Aberdeen Grammar School and Aberdeen University and a pretty useless golfer.
Douglas was a scratch golfer. At the Treasury he reportedly settled a dispute with former colleagues in Edinburgh over a game of golf. He retired in 1951 to his home in Bishop’s Stortford where he died two years later.
Their achievements and those of colleagues who built the NHS were recalled in 1952 in a history of the service written by another Scotsman, Sir James Stirling Ross. He had spent most of his career in the Air Ministry but came out of retirement to serve as a regional advisor to the health department in the run-up to the creation of the NHS.
Ross also had a sense of humour – recording the first NHS joke: Two women met in the doctor’s surgery. Said Mary: “Hello, Jeannie. I didna see ye here last week. What was wrong? Were ye no’ weel?”
Chris Holme is a former Reuters Foundation fellow in medical journalism and worked as a communications manager at the Scottish Government until 2011