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Feature NHS at 70

Providing care based on need and free at point of delivery is NHS’s greatest achievement, say BMJ readers

BMJ 2018; 361 doi: (Published 27 June 2018) Cite this as: BMJ 2018;361:k2770


Whose needs? Histories of “need” in the National Health Service

  1. Tom Moberly
  1. UK Editor, The BMJ
  1. tmoberly{at}

The BMJ conducted a poll to mark the NHS’s 70th anniversary. Tom Moberly examines the results

Readers of The BMJ have voted “providing care based on need and free at the point of delivery” as the NHS’s greatest achievement in its 70 years.

The BMJ’s poll to determine the NHS’s biggest success since its launch on 5 July 1948 attracted more than 5500 votes. Providing free care based on need came just ahead of “limiting commercial influence on patient care” and “general practice as the foundation for patient care” (see boxes).

Harold Ellis, the eminent professor of surgery who now teaches anatomy part time at King’s College London, remembers the difference that providing care based on need and free at the point of delivery made when the NHS was introduced. He qualified in 1948 and was training in Oxford when the NHS was launched on 5 July.1 “I was a student in the hospital before the health service came in,” he says.

“The lady almoner [distributor of funds to poor people] would go around to the patients finding out what their financial state was. If they were penniless they would be treated freely. If they were working she would work out some sort of assessment for them and suggest a payment for the time that they were in hospital.”

Ellis says that although the hospital in which he worked in Oxford was well funded, those in other areas often struggled to find enough funds to treat patients. “I was born and bred in Stepney, and The London was my hospital,” he says. “I always remember as …

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