From cradle to NHS 70

The RCP was instrumental in the establishment of the NHS on 5 July 1948, endorsing the ambitions to meet the needs of everyone, to be free at the point of delivery and to be based on clinical need not the ability to pay.

Our library, archive and museum services manager Julie Beckwith reflects on the RCP’s role right from the start.

Following the introduction of the National Insurance Act in 1911 and the BMA’s outline for a general medical service in 1929–30, RCP fellow Sir Arthur MacNalty investigated setting up a national health service. Other fellows were involved in planning what became the Emergency Medical Service during the Second World War and the RCP was represented on the Central Medical War Committee. 

Also during the Second World War, the BMA medical planning committee included representatives from the RCP. One of them was Sir Charles Wilson, later Lord Moran, who became RCP president in 1941. Lord Moran played a crucial part in the establishment of the NHS and in persuading RCP fellows to accept it. 

The Beveridge report was a great source of discussion by fellows in 1943, resulting in being key to the founding of a welfare state. Fellows did not support the idea of local authorities being in charge and they distrusted political interference in professional areas. However, they supported the idea of the availability of care for all as long as private practice continued. 

The report led to a committee, and the committee, chaired by Lord Moran, favoured the establishment of a comprehensive medical service but wanted private practice to remain an option for those that wanted it. 

Not all fellows approved of the idea but eventually the RCP agreed to support the principles of a comprehensive medical service.

Julie Beckwith, RCP library, archive and museum services manager

RCP fellows also discussed the establishment of such a service. Not all fellows approved of the idea but eventually the RCP agreed to support the principles of a comprehensive medical service, although alternative governance arrangements were suggested. A document was prepared for Comitia in January 1945 and was almost certainly written by Lord Moran. In it, the RCP is described as ‘hardly changing with the times’. It finished with the confirmation (or perhaps warning to the fellowship): “The College does not desire to oppose the government’s intention to make available to the whole population a Comprehensive Medical Service.”  

RCP fellows eventually approved the principles of the National Health Bill in April 1946. The Lancet commented:

For the first time one of the principal organisations of the profession has made a public statement on the National Health Service which emphasises support rather than objections … In associating itself with this proposal for effective reform the College has shown both a sense of realities and a spirit of cooperation which will strengthen public confidence in the profession.

But even after the bill received royal assent in November 1946, the medical profession, including RCP fellows, continued to disagree about the new health service. Many doctors thought that entering into discussions with the government would compromise their position by implying their approval and acceptance of the act. 

Bevan thought this was due to a misunderstanding of the proposals and commented: "The issue for the medical profession today is … whether they will accept or forgo the opportunity to influence its shaping.”

Although the council of the BMA passed a resolution in favour of opening negotiations in early 1947, relationships did not improve with neither side trusting the other. Lord Horder, also a fellow of the RCP and a competitor with Lord Moran for the RCP presidency, carried out his opposition through the BMA committees. Moran continued to have the support of the younger RCP fellows. 

Despite the different views, the NHS began on 5 July 1948 and the RCP has continued to support it and to lobby the government to improve it ever since.

Julie Beckwith, RCP library, archive and museum services manager