NHS Reforms timeline | The Nuffield Trust

The history of NHS reform

This interactive timeline brings 70 years of reform to the National Health Service to life, charting the evolution of this public institution from its inception in the post-war years through to the present day.

We welcome your feedback – email us at: timeline@nuffieldtrust.org.uk

Using the timeline: hover over the arrows on the right/left-hand side of the screen to scroll through the decades, or click on a year above to jump to that decade. Click on the magnifying glass to read more about a particular event.

With thanks to Geoffrey Rivett, contemporary health historian and author of the website: www.nhshistory.net, for his help in editing and reviewing the timeline content.
1942December

Medical treatment covering all requirements will be provided for all citizens by a national health service
Sir William Beveridge (1942)
Sir William Beveridge’s report, Social Insurance and Allied Services, proposes major changes to create the foundations for a welfare system and, in its support, a national health service (the details are left for later).

1942December

Medical treatment covering all requirements will be provided for all citizens by a national health service
Sir William Beveridge (1942) Social Insurance and Allied Services (The Beveridge Report)
The right to medical treatment for everyone under a new national health service is proposed by an inter-departmental committee led by Sir William Beveridge. The committee was asked to: “undertake, with special reference to the inter-relation of the schemes, a survey of the existing national schemes of social insurance and allied services”.

One of the provisions of Beveridge’s committee was that: “medical treatment covering all requirements will be provided for all citizens by a national health service organised under the health departments and post-medical rehabilitation treatment will be provided for all persons capable of profiting by it”.
1944Feburary

The White Paper, A National Health Service, is published, which was prepared by Minister for Health, Henry Willink.

1944February

Wide-ranging discussions with the medical professions and health organisations, culminates in a complex plan in which local authorities play a major role.

Image credit: © IWM ((MOW) L 55651).
1945July

The 1945 British General Election takes place in early July following a month-long campaign.

1945July

Both the Conservative and Labour parties commit themselves to ensuring free access to health care services in their respective manifestos. Choice of general practitioner (GP) features prominently as a priority, as does the need to improve maternity services.

Image: Clement Atlee who served as British Prime Minister from 1945 to 1951. Credit: Wikimedia Commons, 1957.
1945August

Anuerin Bevan is made Minster for Health following the 1945 General Election.

1945August

Following Labour’s victory in the 1945 General Election, Aneurin ‘Nye’ Bevan is appointed Minister of Health (and housing) by Prime Minister Clement Atlee.

Bevan discards previous compromises and takes new proposals to Cabinet. The proposals include a system based on regions and taking all hospitals into public ownership.

Image: Statue of Aneurin Bevan in Cardiff. Credit: Wikimedia Commons, 2005 © Kaihsu Tai.
1946July

The National Health Service Act 1946 is published.

1946July

Anuerin Bevan publishes his National Health Service Act [pdf].

The Act sets out a duty for 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 and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services... The services provided shall be free of charge, except where any provision of this Act expressly provides for the making and recovery of charges.”

Two years of acrimonious debate follows, with the majority of doctors opposed to the introduction of the National Health Service (NHS).

Image: Public information leaflet issued at the birth of the NHS, 1948. Credit: © Department of Health.
1948July 5

This is the biggest single experiment in social service that the world has ever seen undertaken.
Aneurin Bevan (1948)
The National Health Service (NHS) is created.

1948July 5

This is the biggest single experiment in social service that the world has ever seen undertaken.
Aneurin Bevan, 7 October 1948, cited in Timmins N ed (2008) Rejuvenate or retire: Views of the NHS at 60. Nuffield Trust.
The NHS is founded on 5 July 1948, following an official unveiling at Park Hospital (now Trafford General Hospital) in Manchester. 1,143 voluntary hospitals with some 90,000 beds and 1,545 municipal hospitals with 390,000 beds are subsumed within the new NHS.

General practitioners remain self-employed and largely independent, having argued successfully for a contract for service rather than a contract of service.

A new three-part bureaucracy is created to manage the service, comprising: 14 regional hospital boards (RHBs), 36 boards of governors for teaching hospitals (BGs) and 388 hospital management committees (HMCs); 138 executive councils (ECs); and 147 local health authorities (LHAs).
1949December

The NHS is given the power to levy a charge for prescriptions.

1949December

The National Health Service Act 1946, which set up the NHS, contains a provision that NHS services should be provided free of charge unless that Act expressly provided for a charge.

Legislation providing for a prescriptions charge is passed by the Labour Government through the NHS (Amendment) Act 1949. This allows for such a charge, and exemptions to it, to be introduced by regulations.

Although the power is introduced in 1949, the charge itself is not introduced until 1952.

Image credit: Wikimedia Commons, 1946 © R Lee.
1949

It is the policy of the Government to relieve nurses of all work not requiring nursing skill.
Baron Shepherd, House of Lords Chief Whip (1949)
The Nurses Act 1949 establishes a modern framework for the role of nursing within the NHS. Rising costs give cause for concern.

1949

It is the policy of the Government to relieve nurses of all work not requiring nursing skill.
Baron Shepherd, House of Lords Chief Whip, House of Lords Debate, 3 May 1949, vol 162, cols 159–98.
A depleted labour market after the war means that the Government has begun to look overseas to help increase nursing numbers and the UK sees a large influx of nurses from the Caribbean.

The Nurses Act 1949 enacts many recommendations from the 1946 Wood Committee, which was set up by the Ministry of Health to examine the role of nursing in the new NHS.

The educational role of the [then] nurse regulator – the General Nursing Council (GNC) – is strengthened and a new syllabus for general training is completed and approved in 1952.