Intended for healthcare professionals

Analysis NHS at 60

A centrally funded health service, free at the point of delivery

BMJ 2008; 336 doi: (Published 19 June 2008) Cite this as: BMJ 2008;336:1410
  1. Tony Delamothe, deputy editor
  1. 1BMJ, London WC1H 9JR
  1. tdelamothe{at}

Funding the NHS solely through taxation has led to tensions throughout its history. But, as Tony Delamothe reports in his fourth article on the NHS, it still looks like the most efficient option

The vision for a national health service came with the haziest of price tags, and it wasn’t long before the bills started piling up. To balance the books, patient charges were introduced in 1951 for dentistry and ophthalmic services, and for prescriptions a year later. To curb the perceived profligacy of the service’s early days a ceiling was set on NHS spending—the annual contribution from direct taxation was limited to about £400m (€500m; $780m) at 1950 prices.1

NHS pledges on charges2

“There are to be no fees or charges to the patient, with the following exceptions:

  • (i) There will be some charges … for the renewal or repair of spectacles, dentures and other appliances, where this is made necessary through negligence…

  • (ii) There will be charges (taking into account ability to pay) for the provision of domestic help under the Bill for certain good or articles (eg supplementary foods, blankets etc) which may be provided in connection with maternity and child welfare or the special care or after-care of the sick.

  • (iii) It will be open to people if they wish, in certain cases, to pay for additional amenities within the arrangements of the service—eg to pay for articles or appliances of higher cost than those normally made available, or to pay charges for private rooms in hospitals”

Patient charges still exist (mainly for dental services and prescriptions), but they currently comprise just 1.3% of total NHS spending in the United Kingdom—the lowest proportion since charges were introduced. The remaining 98.7% of NHS spending is centrally funded, with 80.3% coming from taxation and 8.4% from National Insurance.3

So, even …

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