through the rates and government grants. Many hospitals were old and in serious need of repair. Some were converted workhouses.

There had been concerns about the health of the nation for some years. Health had been improving since the mid-19th century but there were still pressing health needs. In 1939 about one child out of every twenty died before their first birthday. Infectious diseases such as pneumonia, meningitis, diphtheria, tuberculosis and polio were major killers.

Increasingly, it was felt that the introduction of a national health service, funded from taxation and national insurance, would mean that everyone would receive health care equally, that the ramshackle hospital service would be organised more efficiently and that the nation’s health would improve dramatically. But this could only happen if, as in education, the state took responsibility for health care. Aneurin Bevan, Minister for Health, drew up

plans for a health service, which were outlined in the National Health Act of 1946. The aim was to establish a ‘comprehensive health service to secure the improvement in the physical and mental health of the people … and the prevention, diagnosis and treatment of illness.’ Services were to be ‘free of charge’.

Taking over the hospitals

On 5 July 1948 the National Health Service came into being. The government became caretaker of 2,688 hospitals – 1,143 voluntary hospitals providing some 90,000 beds and 1,545 municipal hospitals with about 390,000 beds, of which 190,000 were in hospitals for the mentally ill. The NHS was launched as a single organisation based on 14 regional hospital boards. There were three parts: hospital services; family doctors, dentists, opticians and pharmacists; and local authority health services, including community nursing and health visiting. Immediately, millions signed on with a doctor. Inpatient care soared from 2.9 million people in 1949 to 3.5 million in 1953, while outpatient care rose from 6.1 million people in 1949 to 6.7 million in 1953.

Difficulties and labour shortages

The new NHS was far more costly than anyone could have expected but there was a wish for it to succeed. The government’s first priority was to

reorganise the hospitals. However, Britain was suffering the after-effects of war: food was rationed, the economy needed rebuilding and bomb damage meant resources were needed to build new homes rather than new hospitals. There was also a serious labour shortage. To rebuild the country, Britain needed more workers, particularly in low-paid jobs that white British people were not willing to do. The new health service was no exception. It was desperately short of staff – nurses, midwives, ancillary workers, cleaners, cooks and porters.

An urgent national need

In 1945 a government report produced by Aneurin Bevan and others – Staffing the Hospitals: An Urgent National Need – highlighted a ‘woeful’ shortage of nursing staff. According to the report there was an immediate need for at least 30,000 more nurses and midwives and about 12,000 domestic and other hospital workers. Without them the new NHS would not be able to function. Two years later the trade union COHSE called on the government to initiate a national recruiting campaign ‘to meet the grave shortage of nursing personnel’. In 1948 the report of the working party on the Employment in the United Kingdom of Surplus Colonial Labour stated that there were 54,000 vacancies for nursing staff in Britain. The most serious shortages were in hospitals for the chronic sick, in mental hospitals and in geriatric nursing, none of which were particularly popular areas of nursing.

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