Social History of Medicine Advance Access originally published online on October 19, 2008
Social History of Medicine 2008 21(3):437-460; doi:10.1093/shm/hkn064
| ||||||||||||||||||||||||||||||||||||||||||||||||
NHS at 60: Perspectives on Health Care Systems |
The British National Health Service 1948–2008: A Review of the Historiography
* Centre for History in Public Health, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: Martin.Gorsky{at}lshtm.ac.uk
 |
Abstract |
|---|
This article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevan's ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.
Keywords: National Health Service; historiography; primary care; hospitals; welfare state; policy; financing