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This Briefing has been produced to mark the 70th anniversary of the inauguration of the National Health Service on 5 July 1948. The Briefing provides a broad history of the NHS since its creation. It focuses on some of the key structural reforms made to the service and provides an overview of the policy approach of successive governments. The final section looks at the history of the NHS from a statistical perspective. It presents data on the cost of the NHS, measures of its size, and considers several key performance indicators.

On 5 July 1948, the Health Secretary, Aneurin Bevan, launched the NHS at Park Hospital in Manchester. At its inauguration, it was financed almost entirely from central taxation. Everyone was eligible for care, and it was to be free at the point of use. However, some charges have subsequently been introduced, such as those for prescriptions.

At its inception, the new service was based on a tripartite system of administration, with hospitals, general practice and local health authorities run separately. During the 1970s a major reorganisation of the NHS took place, and this system was replaced. Regional authorities were established and became responsible for all three parts of the NHS. Further reform has since taken place. However, when devolution took effect in 1999, and certain powers were transferred from the UK Westminster Parliament to the Scottish Parliament, Welsh Assembly, and the Northern Ireland Assembly, health became a largely devolved matter. This has led to a greater divergence of policy than previously between the different countries in the UK.

The overall cost of the NHS has grown faster than the wider economy. Since its inception, NHS expenditure has risen more than tenfold in real terms and more than doubled as a percentage of Gross Domestic Product. Data on the NHS workforce also illustrates its growth, with one estimate suggesting that it is the world’s fifth largest employer. Since inauguration, nurse and general practitioner numbers have more than doubled, and consultant numbers risen more than tenfold. There is also a range of possible indicators of performance for the NHS. Using high-level health outcomes such as infant mortality and life expectancy, the last 70 years have seen significant improvements. Patient experience targets and customer satisfaction statistics show a more mixed picture, but this is only measurable on more recent data.

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