The National Health Service Act 1946 received royal assent on 6 November 1946, providing the statutory basis for the creation of the National Health Service (NHS) in England and Wales. The act provided the central pillar of the post-war welfare state, constructed by the Labour government under Clement Attlee as prime minister.

The legislation’s core principle was the creation of a comprehensive health service, funded publicly and available to the entire population free at the point of use.

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The political momentum behind the legislation, which came into effect on 5 July 1948, was provided by the publication of the Beveridge Report in 1942.

The report, commissioned by the wartime national government, argued that the state should provide a safety net for its citizens from “cradle to grave”. It called for widespread reforms to the system of social welfare, identifying “Disease” as one of the “five giants on the road of reconstruction”. Beveridge’s scheme of post-war reconstruction included a “comprehensive health and rehabilitation services for prevention and cure of disease and restoration of capacity for work, available to all members of the community”.

This recommendation was the foundation of a 1944 white paper, produced by the wartime national government, which endorsed the principle of a “comprehensive health service for everybody in this country”.

It added: “They want to ensure that in future every man and woman and child can rely on getting all the advice and treatment and care which they may need in matters of personal health”.

Labour, committed to the full implementation of the Beveridge proposals, won a landslide victory at the 1945 general election.

Labour’s election manifesto stated: “The best health services should be available free for all. Money must no longer be the passport to the best treatment. In the new National Health Service there should be health centres where the people may get the best that modern science can offer, more and better hospitals, and proper conditions for our doctors and nurses.”

Aneurin “Nye” Bevan, the minister for health in Attlee’s cabinet, presented the National Health Service Bill to the House of Commons on 19 March 1946.

The bill went further than previous proposals – notably in its provisions for the nationalisation of hospitals. Upon becoming law, the act ultimately transferred ownership of both 1,143 voluntary hospitals and 1,545 municipal hospitals into state control, effectively ending local and charitable ownership of hospital services – which was a major source of controversy during its parliamentary stages.

The Conservative Party was steadfastly opposed to attempts to transfer ownership of hospitals from local authorities and charities to the new NHS.

The British Medical Association (BMA), representing many doctors, also opposed the bill. It resisted the possibility of general practitioners (GPs) becoming a salaried state service, arguing these measures threatened professional clinical independence.

Dr Alfred Cox, a former BMA official, stated that the plan to develop the NHS was “like the first step, and a big one, towards National Socialism as practiced in Germany.”

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As health minister, Bevan steered the bill through the House of Commons.

Bevan, addressing the commons at second reading, argued that the scheme was essential on the grounds that “money ought not to be permitted to stand in the way of obtaining an efficient health service.”

The existing healthcare system was “the wrong way round”, he said. “A person ought to be able to receive medical and hospital help without being involved in financial anxiety.”

Bevan dismissed the sentimental attachment to small local hospitals, referring to a “tendency in some quarters to defend the very small hospital on the ground of its localism and intimacy”. He said he would “rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one.”

As such, Bevan said that he had “decided that the only thing to do was to create an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service”.

The health minister, having spoken for over an hour, concluded: “I believe it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.

“For that reason, and for the other reasons I have mentioned, I hope honourable members will give the bill a second reading.”

The central Conservative critique of the NHS was that it amounted to a system of state control.

Richard Law, speaking for the opposition, began: “[Bevan] has received an ovation from the Benches behind him for a speech as eloquent, as unconvincing, and as disingenuous as any I have ever heard from him.”

Law said it was extraordinary that a minister with “no administrative experience of a great government department, and who has no great knowledge, either practical or theoretical, of the very important subject matter with which this bill is dealing, should have set his own intuition and judgment against all those best informed in the medical profession and in the hospital services outside the House.”

Law, however, was forced to withdraw his mistaken remark that the Royal College of Obstetricians had claimed that a national health service would “lead to a great increase in maternal mortality”.

One Labour MP, Dr Hyacinth Morgan, produced a “copy of the document sent out by the Royal College of Obstetricians” and forced Law to recite it.

But the Conservative frontbencher added: “The plain fact is that everybody of informed and expert opinion outside this House is against the minister on one part of the bill or another…

“It is a monstrous perversion of the ordinary usage of words to describe great, responsible, professional bodies… as vested or sectional interests.”

Law (son of Bonar) argued moreover that making doctors salaried employees of the state would subvert their loyalty to the patient. “The doctor’s only loyalty and only responsibility should be to his patients… certainly he should not be responsible to the state”, he said.

The bill’s second reading debate concluded on 2 May. It was passed by 359 votes to 172. The bill then secured its commons third reading by 261 votes to 113 on 26 July.

Conservative MPs voted against the legislation on both occasions.

The final act stated: “It shall be the duty of the minister of health… to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.

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After the act received royal assent on 6 November, a period of intense negotiations followed between the government and the BMA.

In a commons debate on 9 February 1948, Bevan affirmed the government’s determination to begin NHS provision on ‘appointed day’ of 5 July 1948. It came as the BMA conducted a plebiscite among doctors to determine whether they would enter the service – the first of two.

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Bevan told the House: “During the last six months to a year there has been a sustained propaganda in the newspapers supporting the party opposite, which has resulted in grave misrepresentation of the nature of the health service and of the conditions under which the medical profession are asked to enter the health service.

“There has been even worse misrepresentation, sustained by a campaign of personal abuse, from a small body of [BMA] spokesmen who have consistently misled the great profession to which they are supposed to belong.”

Bevan referred to a “small body of raucous voiced people” within the BMA, which he accused of pursuing a “squalid political conspiracy”.

He said: “I make a distinction… between the hard-working doctors who have little or no time to give to these matters, and the small body of raucous voiced people who are alleged to represent the profession as a whole…

“This small body of politically poisoned people have decided to fight the Health Act itself… The whole thing begins to look more like a squalid political conspiracy than the representations of an honoured and learned profession.”

Bevan was confident that public opinion was one his side. He condemned what he saw as the “organised sabotage of an act of parliament” and suggested that the very sovereignty of parliament was under threat.

“We have not yet made BMA House into another revising chamber”, he declared. “We have never accepted the position that this House can be dictated to by any section of the community.”

He referred to his scheme, a national health service, as “the most civilised thing in the world”. The government, despite the BMA’ opposition, still planned to “put the welfare of the sick in front of every other consideration”.

R. A. Butler, speaking for the Conservative party, responded: “One never thought that the minister of health was possessed of a bedside manner, and on this occasion I am sure we have not been disappointed.”

Butler described Bevan’s handling of negotiations with the BMA as “inept” and the scheme as a whole as in “grave danger”.

He told the House: “The right honourable gentleman has imported into the argument such words as ‘squalid political conspiracy’, and has done so deliberately because he knows that it is in the waters of squalid politics that he most enjoys himself…

“You cannot nationalise conscience; it is no good trying to do so, and it is no good the minister thinking that he can get agreement unless he can get the confidence of the profession.”

In May, a second BMA plebiscite was held on the medical profession’s participation. The BMA council, appealing to its members, maintained that while Bevan had made concessions, “the freedoms of the profession are not sufficiently safeguarded” by the act.

The second plebiscite, however, reflected a weakening of the medical profession’s opposition to the scheme.

In February 1948, only 4,084 doctors voted in favour of participating in the NHS – of which 2,500 were general practitioners and their assistants. 25,340 doctors voted no.

Some months later, 12,799 doctors voted ‘Yes’ (versus 13,891 noes) – and of the affirmative votes, 8,639 were general practitioners.

This latter figure was seen as sufficient for Bevan to implement his system of comprehensive healthcare.

The BMA had previously stated that it would advise the medical profession against participation if 13,000 general practitioners voted against serving.

After the May 1948 plebiscite, therefore, the BMA recommended that its members support the new national health service. The organisation said it would “advise the profession to cooperate in the new service on the understanding that the minister will continue negotiations of outstanding matters”.

Bevan ultimately conceded the right for GPs to receive capitation fees (payments based on the number of patients) rather than a set government salary. He also allowed doctors to continue private practice in parallel with work for the NHS.

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On 4 July, on the eve of the creation of the NHS, Bevan launched a famous vitriolic attack on the Conservative Party.

In a speech marking the anniversary of Labour’s accession to power, he declared: “The eyes of the world are turning to Great Britain. We now have the moral leadership of the world, and before many years are over we shall have people coming here as to a modern Mecca, learning from us in the twentieth century as they learned from us in the seventeenth century…

“That is why no amount of cajolery, and no attempts at ethical or social seduction, can eradicate from my heart a deep burning hatred for the Tory Party that inflicted those bitter experiences on me.

“So far as I am concerned they are lower than vermin.”

The NHS commences operations on 5 July 1948 as planned, with 20,000 GPs – some 90% of the total – signed up.

Bevan launched the National Health Service at Park Hospital in Manchester, where he met the NHS’s first patient, 13-year-old Sylvia Diggory.

Diggory later recalled: “Mr Bevan asked me if I understood the significance of the occasion and told me that it was a milestone in history – the most civilised step any country had ever taken, and a day I would remember for the rest of my life – and of course, he was right”

In 1948, Bevan remarked that he brought the BMA on side “by stuffing the doctors’ mouths with gold.”

In 1951, Bevan resigned as minister of health – alongside Harold Wilson as president of the Board of Trade – in opposition to the introduction of charges for items like prescriptions and spectacles. The move came as Britain struggled to finance its part in the Korean War.

This saga proved the first of many controversies over changes to the NHS throughout its long history.