The British National Health Service 1948-2008: A Review of the Historiography

Abstract

SummaryThis article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevan's ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.

A critical account of the rise and spread of ‘leadership’: The case of UK healthcare

“…From the origins of the NHS until the mid-1980s, "administration" was the term overwhelmingly preferred for formal organizational functions, within official documents and mundane discourse (Gorsky, 2008). Administration was finally displaced from its dominance by "management" in the mid-1980s, following the publication of the NHS Management Inquiry, the Griffiths Report (Klein, 2006), and for the next 10-15 years those with formal organizational authority (including clinicians) were almost invariably referred to as managers (Hunter, 1996).…”

A Historical View on Health Care: A New View on Austerity?

“…From the earliest days of the National Health Service (NHS), for example, concerns about how much to spend on health care in order to ensure 'good health' turned on the knotty problem of deciding how to measure this 'good health' such that it could be appropriately monetized. As the NHS Royal Commission in 1979 pointed out, without an "objective or universally acceptable method of establishing what the 'right' level of expenditure on the NHS should be," there is no way to assess how much spending is enough [16].…”

Into the Dark Domain: The UK Web Archive as a Source for the Contemporary History of Public Health

“…This legislation is best known for the changes it wrought to the structure of Britain's NHS, bringing to fruition the policy trajectory begun in 1989 of introducing an ‘internal market’ to the service. 13 The 2012 Act abolished the last tiers of state planning structures to leave a putatively autonomous and self-correcting system. 14 One outcome of this was the relocation of public health, which was moved from the now defunct NHS bodies into local government.…”