There and back again: a short history of health service reform in England from 1909-2012

The National Health Service (NHS) in England and the UK was established on the 5th July 1948 and marked the conclusion of a series of events and reforms that had been gathering momentum for a number of decades. Prior to 1948, health service provision had been poorly coordinated and standards of care were highly variable from region to region. From the point of view of the patient, therefore, the quality of their hospital, and the standard of treatment provided, was largely dependent on their geographical location and socio-economic status. This paper considers the process of health service reform in England over the last 100 years and explores some of the factors that contributed to the creation of the NHS. It examines the transformation of the service since 1948, as it has evolved to meet the demands of a constantly changing social, economic and political environment. Finally, it investigates to what extent the service is beginning to unravel as service-providers face an increasingly uncertain financial future in a progressively competitive marketplace.