National Health Service
The National Health Service is the collective term for the four separate publicly funded healthcare systems of the United Kingdom: the National Health Service, NHS Scotland, NHS Wales, and Health and Social Care which was created separately and is often referred to locally as "the NHS". The original systems were established in 1948 as part of major social reforms following the Second World War, and officially launched at Park Hospital in Davyhulme, near Manchester, England. The founding principles were that services should be comprehensive, universal and free at the point of delivery. Each system provides a comprehensive range of health services, provided without charge for residents of the United Kingdom apart from dental treatment and optical care, though NHS patients in England who are not exempt have to pay prescription charges.
Taken together, the four systems in 2015–16 employed around 1.6million people with a combined budget of £136.7billion. In 2024, the total health sector workforce across the United Kingdom was 1,499,368.
When purchasing consumables such as medications, the four healthcare systems have significant market power that influences the global price, typically keeping prices lower. A small number of products are procured jointly through contracts shared between systems. Several other countries directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements.
History
Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909. However, following the Dewar Report of 1912, the Highlands and Islands Medical Service was brought into being that provided centrally planned healthcare services, over half of Scotland's landmass, at minimal cost to patients – in many ways a prototype for NHS Scotland.Somerville Hastings, President of the Socialist Medical Association, successfully proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service.
Following the 1942 Beveridge Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease", cross-party consensus emerged on introducing a National Health Service of some description. Conservative MP and Health Minister, Henry Willink later advanced this notion of a National Health Service in 1944 with his consultative White Paper "A National Health Service" which was circulated in full and short versions to colleagues, as well as in newsreel.
When Clement Attlee's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister. Bevan then embarked upon what the official historian of the NHS, Charles Webster, called an "audacious campaign" to take charge of the form the NHS finally took. Bevan's National Health Service was proposed in Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament's Public Health Services Act 1947.
NHS Wales was split from NHS in 1969 when control was passed to the Secretary of State for Wales. According to one history of the NHS, "In some respects the war had made things easier. In anticipation of massive air raid casualties, the Emergency Medical Service had brought the country's municipal and voluntary hospitals into one umbrella organisation, showing that a national hospital service was possible". Webster wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades".
The NHS was born out of the ideal that healthcare should be available to all, regardless of wealth. Although being freely accessible regardless of wealth maintained Henry Willink's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose the personal relationship between doctor and patient.
Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour government defeated Conservative amendments resulting in the implementation of a centralised health service model.
The National Health Service has never been a single organisation. The initial structure in 1948 introduced a number of management bodies for England and Wales. These were as follows:
- 14 regional hospital boards
- 36 boards of governors for teaching hospitals
- 388 hospital management committees
- 138 executive councils
- 147 local health authorities
Community and domiciliary health services such as home nurses, public and environmental health and health prevention/promotion continued to be run by separate, elected local municipal Authorities or Councils.
The first general medical services contract was brought in as part of the NHS's inception. This built on arrangements with general practitioners as part of the National Insurance Act 1911. This resulted initially in 18,000 self-employed general practitioners.
At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.
Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures, dentists, and glasses; resigning in support was fellow minister and future Prime Minister Harold Wilson. The following year, Winston Churchill's Conservative government introduced prescription fees. However, Wilson's government abolished them in 1965; they were later re-introduced but with exemptions for those on low income. These charges were the first of many controversies over changes to the NHS throughout its history. The Tony Blair Labour governments would later implement large scale financing arrangements with private builders in private finance initiatives and joint ventures.
From its earliest days, the cultural history of the NHS has shown its place in British society reflected and debated in film, TV, cartoons and literature. The NHS had a prominent slot during the 2012 London Summer Olympics opening ceremony directed by Danny Boyle, being described as "the institution which more than any other unites our nation".
Eligibility for treatment
Some health services are free to everyone, including accident and emergency room treatment, registering with a GP and attending GP appointments, treatment for some infectious diseases, compulsory psychiatric treatment, and some family planning services.Everyone living in the UK can use the NHS without being asked to pay the full cost of the service, though NHS dentistry and optometry have standard charges in each of the four national health services in the UK. Most patients in England have to pay charges for prescriptions though some patients are exempted.
People who are not ordinarily resident may have to pay for services, with some exceptions such as refugees. Patients who do not qualify for free treatment are asked to pay in advance or to sign a written promise to pay for treatment.
There are some other categories of people who are exempt from the residence requirements such as specific government workers, those in the armed forces stationed overseas, and those working outside the UK as a missionary for an organisation with its principal place of business in the UK.
Citizens of the EU or European Economic Area nations holding a valid European Health Insurance Card and people from certain other countries with which the UK has reciprocal arrangements concerning health care can get NHS emergency treatment without charge. People from the EU without an EHIC, Provisional Replacement Certificate or S1 or S2 visa may have to pay.
People applying for a visa or immigration application for more than six months have to pay an immigration health surcharge when applying for their visa and can then get treatment on the same basis as a resident. There are some people who do not have to pay, including health and care workers and their dependents, dependents of some members of the armed forces, and victims of slavery or domestic violence. In 2024, the charges were £776 per year for students, their dependents, those on Youth Mobility Schemes, and those under aged 18, and £1,035 for all other applicants who are not covered by exemptions.
Funding
The NHS is funded from the general budget, partially accounted for by National Insurance contributions, plus around 1% of patient charges for some services.In 2022/3, £181.7billion was spent by the Department of Health and Social Care on services in England. More than 94% of spend was on salaries and medicines.
In 2024/5, the NHS in Wales budgeted £11.74billion for health and social care, which was 49% of its budget.
£19.5billion was budgeted for health and social care in Scotland for 2024/5.
£7.3billion was budgeted for health in Northern Ireland in 2024/5.
Staffing
England's NHS is the largest employer in Europe, with one in every 25 adults in England working for the NHS. Nursing staff accounted for the largest cohort at more than 330,000 employees, followed by clinical support staff at 290,000, scientific and technical staff at 163,000 and physicians at 133,000.Issues
Funding and costs
The funding of the NHS is usually an election issue, and fell under scrutiny during the Covid-19 pandemic.In July 2022, The Telegraph reported that think tank Civitas found that health spending was costing about £10,000 per household in the UK. They said that this was the third highest share of GDP of any nation in Europe and claimed that the UK "has one of the most costly health systems – and some of the worst outcomes". The findings were made before the government increased health spending significantly, with a 1.25% increase in National Insurance, in April 2022. Civitas said that "runaway" health spending in the UK had increased by more than any country despite the drop in national income due to the COVID pandemic.
The Labour Government elected in 2024 stated that their policy was that the "NHS is broken". They announced an immediate stocktake of current pressures led by Labour peer Lord Ara Darzi. This was to be followed by development of a new "10 year plan" for the NHS to replace the NHS Long Term Plan published in 2019.
The potential rise of the cost of social care has been signalled by research. Professor Helen Stokes-Lampard of the Royal College of GPs said in 2017, "It's a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients".