History of the NHS from the Crimea to Covid

Doctors resisted it, and it was over-budget from day one, but Dr Susan Cohen's illustrated overview of this remarkable institution is a timely reminder of how the NHS survived cost-cutting and restructuring to meet its biggest challenge in 2020.

"I have never before written a book that I didn't get out to research but I had previously written about nurses so despite the lockdown I was able to pull together oral history recollections from multiple sources to give it a personal feel," says the social historian, who lives in Hampstead Garden Suburb.

"I have tried to join the dots from events which laid the foundations for the NHS to what we see today."

Elizabeth Fry and Florence Nightingale campaigned for better public healthcare, and the first National Insurance scheme in 1911 introduced health benefits for employees only, but pre-war healthcare was an inadequate mix of the private, charitable and municipal - heavily criticised in AJ Cronin's influential novel The Citadel.

Clement Attlee's incoming Labour government pledged a healthcare system free for all and in June 1948 the NHS was born. Doctors feared for their independence and lucrative private practice, but Health Minister Aneurin Bevan famously "stuffed their mouths with gold". The freedom for consultants to work privately alongside NHS contracts and the provision of private wings in NHS hospitals continues today.

Nurses and midwives learning about the structure of the new NHS circa 1949. (Image: Supplied)

202 million prescriptions were filled in the first year alone, and with 75 percent of over 18s needing dentures, the untapped demand for dental care and glasses drove the NHS over budget. Charge caps and prescription payments were soon introduced and Bevan believed NHS costs would tumble as people's health improved. But as Cohen explains medical advances far exceeded expectations with NICE later established to set guidelines on access to new treatments.

"I don't think you could blame them for their underestimate. In their wildest dreams they can't have thought that so many people would want dentures or get glasses made up, take them home and never wear them. And who could foresee advances in medical science like heart transplants or IVF? The picture of an intensive care ward from the 60s is like being in another world in terms of how things have progressed."

GPs complained of long patient lists and gruelling out of hours rotas but appointment systems and locum services were introduced. Meanwhile the shortage of nurses was filled by inviting people from the West Indies and Ireland to train.

"The NHS employs 1.5million people and has long been reliant on nurses coming from elsewhere often at a cost to those countries."

And vaccination drives of the 50s and 60s against polio, tuberculosis, and measles drove down childhood diseases and reduced pressure on the NHS. "They considered making the smallpox vaccine compulsory by law in 1905 but there was such an outcry they had to backtrack," says Cohen. "Today the internet means anti-vaxers can get their fake information out there and put the fear of God into people."

Ease of immunisation came with the introduction of the Sabin live oral polio vaccine in 1962, which generations of children remember having administered on a sugar cube. (Image: supplied)

Buildings were modernised, Victorian asylums closed, and district nurses in the 60s and 70s took care into the community. But from Thatcher's internal market, to Labour's Primary Care Trusts and budget-holding GPs, the NHS was a hostage to political fortune - even while staff had to campaign for pay rises.

Midwives were among the thousands of health workers who took part in the first strike over pay for more than 30 years (13 October 2014) (Image: Supplied)

"Although I am not a political historian you can't not mention every time a new government comes in they take a broom and try to sweep out the old," says Cohen.

Nigel Lawson once said the NHS is the closest thing the English have to a religion and the weekly clap for carers signalled renewed appreciation of this 72-year-old service. "There have been issues but staff have been working under tremendous pressure and the vaccination drive has been absolutely remarkable, people have really stepped up to the plate. We really should be thankful for the NHS."

Dr Susan Cohen's book on The NHS (Image: Shire Publications)

The NHS: Britain’s National Health Service, 1948-2020 is published by Shire Publications.