The National Health Service came into being in 1948 because, in words attributed to then Minister of Health Aneurin Bevan, 'Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.' Many of the guiding principles of the NHS are well known:
- that it meet the needs of everyone
- that it be free at the point of delivery
- that it be based on clinical need, not ability to pay
One less well-known aspect of the NHS is Aneurin Bevan’s centralising call that 'if a hospital bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall'.
Here, the British Academy explores centralisation and devolution in the NHS, the ‘echo around Whitehall’.
The NHS has always evolved through its history. The next step in its evolution looks likely to be integration and, maybe, devolution. Recent British Academy work shows that some believe the best way to improve services is to embrace devolution and variation so that services can be tailored to the needs of that area. If that happens, the NHS may become National in name only. Find out more in our report Governing England: Devolution and public services.
Martin Rogers is a Policy Adviser in the British Academy Public Policy Team.