Intended for healthcare professionals

Analysis NHS at 60

Founding principles

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1216
  1. Tony Delamothe, deputy editor
  1. 1BMJ, London WC1H 9JR
  1. tdelamothe{at}

    Inthe first in a series ofarticles marking the 60th anniversary of the foundation of the NHS, Tony Delamothe examines what drove its formation

    Britain’s National Health Service (NHS) came into existence on 5 July 1948. It was the first health system in any Western society to offer free medical care to the entire population. It was, furthermore, the first comprehensive system to be based not on the insurance principle, with entitlement following contributions, but on the national provision of services available to everyone.1

    To the founding principles enumerated in this quotation should be added quality and equity. Presenting his National Health Service Bill to parliament in 1946, health minister Aneurin Bevan said “not only is it available to the whole population freely, but it is intended . . . to generalise the best health advice and treatment.”2 The intention was to make the same, high level of service available to all, according to need.3 In other words, the new service could be seen as responding to the old Marxist rallying cry, “From each according to his ability, to each according to his need” and a more familiar enthusiasm for uniform, national standards of excellence.1

    Universal, equitable, comprehensive, high quality, free at the point of delivery, centrally funded—how does the NHS look 60 years after it came into existence? In the next five articles I will be examining how its founding principles have fared. In this article I look at how the socialist dream came to be dreamt in the first place.


    Much has been written about the effects of the second world war in galvanising social change,4 but historians agree with the government’s white paper that “The idea of a full health and medical service for the whole population is not a completely new one, …

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