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My maternal grandparents lived and worked in the south Wales mining valleys and as a child I was made aware of the local charismatic MP, Aneurin Bevan, and his great achievement: the NHS. The National Health Service was launched in 1948. It has been argued that the model for the NHS was inspired by Bevan’s knowledge of the Tredegar Workmen’s Medical Aid Society, where free health and dental care was available to its members for the payment of a penny a week.

Black and white photo shows Aneurin Bevan (architect of the NHS) meeting with nurses

Above: Aneurin Bevan speaks to nurses

1948 – birth of the NHS

In January 1948, Bevan, then Minister for Health and Housing, announced that on 5 July the National Health Service would launch. In those six months, the introduction of the NHS was resisted in parliament and by doctors and dentists who feared a loss of independence. However, the Socialist Medical Association (SMA) actively campaigned in its favour. RCN member Avis Hutt was a radical activist and member of the SMA. As the implementation date grew closer, community doctors began to advertise for patients and with just five weeks to go, the British Medical Association finally ended its resistance.

1948 advert from Scottish newspapers explains the upcoming arrival of the National Health Services and the things it will grant people access to

Above: this advertisement appeared in Scottish newspapers and let readers know what to expect from the NHS

1950s – prescription charges and mass vaccination

My brother was born just 10 weeks after the beginning of the NHS and my mother was heard to say: “I had to pay for our Dianne, but John came free!”  However, that free service only remained truly comprehensive for a short time. The budget of 1951 reduced NHS funding and resulted in Bevan resigning, and in 1952 charges were introduced for prescriptions, spectacles and dental services. There was ongoing underfunding of the service. Nevertheless, health improved, infant mortality reduced, and life expectancy increased. In 1958 the first mass vaccination programme arrived. There were 8,000 cases of polio and 70,000 of diphtheria each year before these vaccinations were offered to all under-15s.

NHS prescription spectacles, which were only available for free for a short period of time before charges were introduced

Above: charges were introduced for NHS-issue spectacles, like the ones above, from 1952

1960s – hospitals for all

Throughout the 1960s – despite long waiting lists, staff unrest over pay and conditions, and a cumbersome bureaucracy – the service continued to have widespread support. The decade saw the creation of district general hospitals. In 1962, Health Minister Enoch Powell’s Hospital Plan set out a vision to build hospitals in every place where there was a population of at least 125,000. Then there was the restructuring of social services and the creation of the Department of Health and Social Security. As a student nurse at the end of that decade, the hospital beds were always full, there was no shortage of equipment or resources, the food for staff and patients was freshly prepared, and much hands-on nursing care was delivered by student nurses. In 1969, the RCN’s Raise the Roof campaign resulted in an impressive 20% pay rise for nurses.

Nurses attend to patients in a hospital ward in the 1960s

Above: nurses and a doctor attend to patients on a hospital ward in the 1960s

1970s – pay rises for nurses

The 1970s have been described as “halcyon days” for the NHS, a time of increased spending and expansion. Yet there were ongoing pay disputes and concern about reforms to the service. In April 1974, the NHS was re-organised with the aim of providing a fully integrated local health service and not everyone was happy with the new layers of bureaucracy. The RCN became increasingly political, nurses pay remained an issue, and the Halsbury Review resulted in an average pay increase of 33%. I was undertaking the two-year sister tutors diploma course at that time. On completing the course and effectively being promoted, I saw a 50% increase in my salary.

Nurses hold banner reading 'Pay not peanuts' as part of a 1969 campaign that led to a significant pay rise for nurses in the NHS

Above: RCN members carry a banner as part of a 1969 pay protest, which led to a pay rise for NHS nurses

1980s – Thatcher’s reforms

The 1980s was a decade of radical change for the NHS, with the introduction of “general management” in 1982 following the Griffiths Report. The Nurses Pay Review Body came into existence after 1983, following an 18-month long pay dispute. At the time, the RCN had a no-strike policy. In the middle of the decade, Project 2000, the first step towards nurse education moving from the NHS to the university sector, was launched and student nurses became supernumerary. The decade ended with social services being split from health at government level, and Margaret Thatcher announcing that there was to be a fundamental review of the NHS: the internal market had arrived.

Nursing staff at North Tees General Hospital gather around a cake topped with candles spelling out '40' to celebrate the NHS's 40th anniversary in 1988

Above: staff at North Tees General Hospital celebrate the NHS's 40th anniversary in 1988

1990s – new legislation and PFIs

The NHS underwent yet more change during the 1990s, with the introduction of the internal market, NHS trusts, a mental health framework and NHS Direct. The advent of Private Finance Initiatives (PFIs) resulted in an explosion in new hospitals being built, but there were serious concerns about staff employment, as non-NHS contracts were awarded for cleaning and catering services. Devolution allowed for flexibility in spending and organisational structure – there was no internal market in Scotland, while Wales abolished the purchaser/provider split and many hospital-based targets. In 1992, following a successful campaign by the RCN, it became possible for nurses to prescribe medications.

In 1999, Tony Blair speaks to a nurse called Karen at the new NHS Direct in Tyneside

Above: Prime Minister Tony Blair speaks to Karen, a nurse working at the newly created NHS Direct in Tyneside in 1999

2000s – Agenda for Change

In 2000 the NHS Plan was regarded as the biggest change in the NHS’s history, offering a 10-year reform programme, but in 2004 the NHS England Five Year Forward View arrived. Agenda for Change, the current and hotly debated job grading and pay system for NHS staff, was introduced. The first years of the new millennium also brought us strategic health authorities, foundation trusts, the Care Quality Commission and the NHS constitution.

Care Quality Commission logo on a white wall

Above: the Care Quality Commission was created in 2009 to regulate health and social care providers

2010s – nurses graduate

Despite promises of no more top-down change, another significant reorganisation was implemented by the Conservative-led coalition government in 2012 when the Health and Social Care Act was passed. In the same year, nursing finally became a graduate entry profession. In 2017, the nursing associate (NA) role was introduced in England to bridge the gap between HCAs and registered nurses.

Four student nurses at University of Northampton pictured in 2017

Above: student nurses at the University of Northampton in 2017. Five years earlier, nursing became a graduate profession

2020s – a global pandemic and historic strikes

I was looking forward to celebrating the bicentenary of Florence Nightingale’s birth in 2020. By the time the date arrived, the COVID-19 pandemic had been declared. Pop-up hospitals named for Nightingale were set up to increase capacity. The NHS and its nursing staff bravely facing the dangers of each pandemic wave, dealing with a lack of appropriate medical and protective equipment, dramatic staff shortages, and the deaths and severe illness of colleagues, loved ones, and patients.

Matron May Parsons was the first person to administer a COVID-19 vaccine outside of clinical trials in December 2020 to patient Margaret Keen

Above: matron May Parsons administered the first out-of-trial COVID-19 vaccine to Margaret Keen in December 2020

Nursing staff were involved in the development of COVID-19 vaccines, helping run clinical trials to test safety and efficacy. On 8 December 2020, May Parsons, a matron at University Hospital Coventry, became the first person in the world to administer a COVID-19 vaccine to a patient outside of clinical trials. The global pandemic has lasting repercussions for the NHS but also led to an overhaul of how services are managed with more trusts using digital resources to care for patients. 

After all this, the Conservative government’s below-inflation pay offer to NHS staff frustrated many. In 2022, RCN members in the NHS voted in favour of strike action in all four UK nations. In England, Northern Ireland and Wales members then took historic strike action, withdrawing their labour for the first time on this scale in the RCN’s 106-year history.

An RCN member holds a Fair Pay For Nursing placard in front of the picket line at Kings Hospital London on 19 January 2023

Above: RCN members on the picket line in south London in January 2023

The future of the NHS

Yet again the NHS in England is undergoing major change – the Health and Social Care Act (2022) aims to support collaboration and partnership working, and I am reminded of the 1974 re-organisation which had similar aspirations. Time alone will see if a fully integrated health and social care service is delivered. 

The NHS continues to experience staff shortages, this has always been the case, but recent strikes by NHS staff have been unprecedented. Despite these challenges I have still been able to access medical advice and guidance. Although I have had to learn new skills to complete online health assessments. 

The only real certainty is that the NHS will always be changing, and it will always be subject to political and parliamentary management. But I am confident it will always be defended and defined by its nursing staff.

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