History of the NHS (2): The dawn of a new era

In 2008, a photographic exhibition by LHSA celebrated the 60^th anniversary of the National Health Service.

The National Health Service (NHS) was launched on 5th July 1948. It heralded a new era of health care for the UK. The main provision was for every man, woman and child to have access to a complete health service, regardless of who they were or where they came from. Medical care and treatment were to be free to all individuals, funded by central taxation.

Back cover of Royal Infirmary of Edinburgh League of Subscribers Annual Report, July 1948 (GD1/38/6).

Leith Day Nursery, South Fort Street, c.1950s (LHSA Photographic Collection) [Image reproduced by permission of The Scotsman Publications Ltd.]. The NHS strengthened and consolidated maternity and child welfare services, which were first established in Scotland at the turn of the century. As well as providing clinical care for expectant mums, babies and young children, it offered further assistance to mothers through ante-natal classes, health visitors, nurseries and play centres.

Sighthill Health Centre, c.1950s. Sighthill Health Centre opened in May 1953 and was the first of its kind in Scotland. Sighthill was chosen because it was a new housing area with a large population that was inadequately served by existing provision. he idea behind it was to create a facility for related health care services under one roof. The Centre housed GP consulting rooms, child welfare and school health services, an NHS dental surgery, a pharmacy and a physiotherapy department.

The NHS brought together a number of existing services which had begun many years before. It provided a uniform national structure that had previously involved voluntary, provident, private and government provision at the hospital and community levels. The main features were: regional hospital boards to co-ordinate hospital services; local health authorities to run community-based services and executive councils to administer GP, dental, chemist and eye services. The complete service offered by the NHS aimed to encompass all aspects of health care from the cradle to the grave. It also promoted good health and welfare in general.

National Health Service (Scotland) Act, 1947. The text reads, 'Chapter 27. An Act to provide for the establishment of a comprehensive health service in Scotland, and for purposes connected therewith. [21st May 1947.]'

Newspaper cartoon, c.1946 (LHSA Pamphlet Collection). This cartoon shows an elderly patient worrying about the potential effects of the new National Health Service. The British Medical Association agreed with the creation of the NHS in principle, but felt it was not properly consulted when the legislation was being developed.

People playing cards and dominos at Sighthill Health Centre, c.1950s [Image reproduced by permission of The Scotsman Publications Ltd.].

Before the NHS, citizens had to pay for medical advice and treatment. Many simply could not afford this. So calling out a doctor, or going to a hospital, often became a last resort, with the result that illnesses or injuries often went untreated altogether, or became more serious than they might have been. The NHS meant that people of all classes no longer had to worry about how they would pay. Care and treatment became a right, not a privilege.

Royal Edinburgh Maternity Hospital (Simpsons) Case Note, 1935 (LHB3 CC1/ 1935/1010). This image is taken from a patient case note and shows a husband and wife's pre-NHS insurance provision. The National Health Insurance Scheme was introduced as part of the National Insurance Act of 1911. It entitled the working man (and in some cases his family) to medical treatment, his wife to maternity care and offered him sickness benefit during periods of his incapacity for work. By the mid-1930s, all manual labourers earning no more than £250 a year were made compulsory members of the Scheme.

Nurse and patient in ambulance, 1942. Before 1948, the ambulance service in Scotland was supplied jointly by the St. Andrew's Ambulance Association and the British Red Cross Society, and funded by voluntary contributions. This joint service continued post-1948, the only change being that the costs were now met by the State.

School Dental Service, c.1950s. Dental check-ups and treatments were free under the early NHS, as were visits to a GP, eye tests and spectacles, hearing tests and hearing aids.

The first part of the exhibition focuses on aspects of pre-1948 health care and selected features of the NHS Scotland Act. The second part provides photographic snapshots of the many components of the service provided by the NHS in Edinburgh.

Royal Edinburgh Hospital Admission Register, 1920 (LHB7/35/12). These volumes recorded several patient details, including an individual's status as 'private' or 'pauper'. If private, the patient or their family would be charged an appropriate board rate. If a pauper, the state would pay the minimum for their care under the provisions of the Scottish Poor Law. Private patients in this psychiatric hospital were housed separately from paupers in finer surroundings and had access to many other privileges which paupers were excluded from.

The NHS has adapted and developed continuously since 1948. Almost immediately, it became apparent that the need for health care in Scotland (and the UK) was enormous and that the cost of meeting it was going to be far higher than previously estimated.

School Medical Service, diphtheria immunisation, 1953. In Scotland, the School Medical Service was established in 1908. For the next 40 years, it was administered and financed at a local level, often with very limited resources. With the coming of the NHS, medical services for school children became the responsibility of the State nationally. It soon began to offer vaccinations and immunisations to all children.

Royal Edinburgh Hospital Case Book, 1916 (LHB7/51/100). This image shows the higher annual board rate paid by this private patient. Despite staff working hard to improve the mental health of all patients, fundamental inequalities remained.

Many people today are quick to associate the NHS with waiting lists, prescription charges and so-called ‘postcode lotteries’. But we should never forget that the fundamental values behind the NHS still remain the same. Anyone who is sick or injured can go to a hospital or a doctor’s surgery and get the help that they need. This was not the case 60 years ago in Scotland and is unfortunately not so in many countries of the world today.

Hospital ward, East Fortune Hospital, 1953. East Fortune Hospital was a tuberculosis sanatorium which opened in 1922. It was converted for this purpose from a World War One naval airship station in Drem, East Lothian. From 1956, the hospital also began to care for children and adults with learning disabilities.

Audience receiving question cards at a health education meeting, New Victoria Cinema, 1947. Health education was not just for mothers and children. Public meetings held in cinemas were organised by the Edinburgh Public Health Department, now a fully integrated part of the NHS. Films were shown followed by question-and-answer sessions on a range of topics. For example, tuberculosis, venereal disease, hygiene and exercise. Anybody could attend without charge.

The 'Audience of 2000' leaving the New Victoria Cinema after a health education meeting focusing on tuberculosis, 13 March 1949 [Image reproduced by permission of The Scotsman Publications Ltd.].

Central Leith Health Campaign, 1955 [Image reproduced by permission of The Scotsman Publications Ltd.]. In the 1950s, Edinburgh worked hard to promote the fight against tuberculosis. The Central Leith Health Campaign of 1955 encouraged people to have their chest x-rayed to detect any signs of the disease. This was followed in 1958 by the Mass Radiography Campaign, which invited all citizens of Edinburgh over the age of 15 to have their chests x-rayed. A staggering 77% of the population took part.

Central Leith Health Campaign, 1955 [Image reproduced by permission of The Scotsman Publications Ltd.].

Window display at Woolwoths, Princes Street promoting 'Health Week', 1952 [Image reproduced by permission of The Scotsman Publications Ltd.]. Edinburgh's 'Health Week' ran from 10th to 18th May 1952 and employed the slogan 'Your Health is Edinburgh's Wealth'.