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“The NHS of the United Kingdom was established in 1948 with the underlying principles that the NHS should be funded predominantly through general taxation, that care should be comprehensive and that access be based on clinical need and not ability to pay. The NHS had been preceded by the 1911 National Insurance Act, which provided health insurance for industrial workers, allowing them access to a developing family doctor service (AbelSmith, 1988). The Second World War had also seen some nationalisation of health services, as hospitals were registered and centrally run from 1938 (Abel-Smith, 1964; Greengross, Grant & Collini, 1999). In Scotland, the Highlands and Islands Medical Service had been providing a state-funded and administered service to an area equivalent to half the land mass of Scotland since 1913 (Wellings et al., 2020). In Wales, schemes such as the Tredegar Workmen’s Medical Aid Society, which provided health care on the basis of weekly contribution, had grown in coverage from the start of the 1900s up to the foundation of the NHS (Thompson, 2018). The NHS built on these existing schemes to provide a national system that was locally delivered.

“From 1948, the NHS served England, Scotland and Wales in a similar manner, while the Northern Ireland’s health system operated semiautonomously. There were differences in the NHS across the constituent countries, including in legislation and parliamentary accountability, but from a patient’s perspective, minimal differences were evident until devolution in 1999 (Greer, 2016). Cylus et al. (2015) provide an account of important changes occurring through the 1970s to 1990s. Before devolution, the then Conservative Government passed the 1990 National Health Service and Community Care Act, which introduced the “internal market”, separating the purchasing and provision of care. GP fundholding was also introduced, which allowed larger GP practices to hold their own NHS budgets to cover a range of costs including staff, prescribing and a limited range of hospital services; in essence, becoming the purchasers of services for their patients. Hospitals and community and mental health services were organised into semi-independent NHS trusts.”

Source: Anderson M, Pitchforth E, Edwards N, Alderwick H, McGuire A, Mossialos E. The United Kingdom: Health system review. Health Systems in Transition, 2022; 24(1): i–192.

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“The National Health Service (NHS) remains a critical element of British governance in the twenty-first century, a high-profile social policy and a prominent component of the contemporary welfare state. Since its creation in 1948, the primary focus of the NHS has been delivering universalized public health needs, with its central ethos aligned with William Beveridge’s original sentiments (in 1942) to provide quality health care ‘from the cradle to the grave,’ directly funded from government taxation and providing unconditional treatment regardless of ability to pay. Indeed, the NHS’s essential mission was concisely summarized by the cabinet minister who presided over its introduction, Aneurin Bevan, who declared in Parliament in 1946 that ‘A person ought to be able to receive medical and hospital help without being involved in financial anxiety’. ¹ This outlook derived from a blend of humanitarian obligations and socialist ideology and values, both of which shaped the original service model, ² and have been central to this policy sphere and associated political debate ever since. The NHS has subsequently been described as having ‘no parallel in terms of its resilience . . . longevity and its abiding appeal’ ³ among the wider population, and within this context, polling has consistently indicated that the NHS retains significant public popularity since its creation amid the collectivist mood in the aftermath of World War Two.

“Former Conservative Chancellor of the Exchequer Nigel Lawson once notably referred to the NHS as ‘the closest thing the English have to a religion, with those who practice it regarding themselves as a priesthood’. ⁴ Such wider reverence has been further strengthened in recent times by the impact of the COVID-19 pandemic and the critical role played by the NHS throughout it. Yet this prolonged episode also exposed the underlying and recurring longer-term challenges pertaining to the sheer size, complexity and demographic variables facing the NHS as an organization (and which was further complicated and recalibrated with the advent of post-1999 devolution). It also raised renewed questions as to whether such foundational socialist and collectivist principles can be sustained amid demographic change, rising costs, and global capitalist structures and dynamics while continuing to deliver its core services into the future, ⁵ particularly in comparison to other western health care systems. Within the context of its vast size and expense, by the first decade of the twenty-first century the NHS had grown to employ approximately 1.4 million people with an annual cost of over £100 billion and rising (in England); which provides significant political challenges in terms of its effective functional operation in the early twenty-first century.”

Source: Williams B. The British NHS at 75: Past, Contemporary, and Future Challenges. Int J Soc Determinants Health Health Serv. 2025;55(1):76-87. doi:10.1177/27551938241280175

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“The archetypal Beveridge model is the traditional system of the United Kingdom, of a single payer, financed by national taxation, with a National Health Service in which providers of publicly financed services are owned publicly, and access to hospital specialists is typically by referral via a general practitioner (GP).”

Source: Bevan G, Helderman JK, Wilsford D: Changing choices in health care: implications for equity, efficiency and cost. Health Econ Policy Law. 2010, 5 (3): 251-67. 10.1017/S1744133110000022.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated August 5, 2025 by Doug McVay, Editor.