The National Health Service (NHS) is the collective term for the four separate publicly funded healthcare systems of the United Kingdom: the National Health Service in England, NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland, which were created separately, and are often referred to collectively or individually as "the NHS".
The three original systems for England and Wales, Scotland and Northern Ireland were established in 1948 – with a Welsh system later founded in 1969 – as part of major social reforms following the Second World War, and officially launched at Park Hospital in Davyhulme, near Manchester, England (now known as Trafford General Hospital). The founding principles were that services should be comprehensive, universal and free at the point of delivery. Each system provides a comprehensive range of health services, provided without charge for residents of the United Kingdom apart from dental treatment and optical care, though NHS patients in England who are not exempt have to pay prescription charges.
Taken together, the four systems in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion. In 2024, the total health sector workforce across the United Kingdom was 1,499,368. When purchasing consumables such as medications, the four healthcare systems have significant market power that influences the global price, typically keeping prices lower. A small number of products are procured jointly through contracts shared between systems. Several other countries directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements.
Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909. However, following the Dewar Report of 1912, the Highlands and Islands Medical Service was brought into being that provided centrally planned healthcare services, over half of Scotland's landmass, at minimal cost to patients – in many ways a prototype for NHS Scotland.
Somerville Hastings, President of the Socialist Medical Association, successfully proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service.
Following the 1942 Beveridge Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease", cross-party consensus emerged on introducing a National Health Service of some description. Conservative MP and Health Minister, Henry Willink later advanced this notion of a National Health Service in 1944 with his consultative White Paper "A National Health Service" which was circulated in full and short versions to colleagues, as well as in newsreel.
When Clement Attlee's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister. Bevan then embarked upon what the official historian of the NHS, Charles Webster, called an "audacious campaign" to take charge of the form the NHS finally took. Bevan's National Health Service was proposed in Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament's Public Health Services Act 1947.
NHS Wales was split from NHS (England) in 1969 when control was passed to the Secretary of State for Wales. According to one history of the NHS, "In some respects the war had made things easier. In anticipation of massive air raid casualties, the Emergency Medical Service had brought the country's municipal and voluntary hospitals into one umbrella organisation, showing that a national hospital service was possible". Webster wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades".
The NHS was born out of the ideal that healthcare should be available to all, regardless of wealth. Although being freely accessible regardless of wealth maintained Henry Willink's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose the personal relationship between doctor and patient.
Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour government defeated Conservative amendments resulting in the implementation of a centralised health service model.
The National Health Service has never been a single organisation. The initial structure in 1948 introduced a number of management bodies for England and Wales. These were as follows:
14 regional hospital boards (RHBs)
36 boards of governors for teaching hospitals (BGs)
388 hospital management committees (HMCs)
147 local health authorities (LHAs)
Local voluntary hospitals were brought into national public ownership. On the 5 July 1948, 1,143 voluntary hospitals comprising approximately 90,000 beds and 1,545 municipal hospitals with around 390,000 beds were taken over by the NHS in England and Wales.
Community and domiciliary health services such as home nurses, public and environmental health and health prevention/promotion continued to be run by separate, elected local municipal Authorities or Councils.
The first general medical services contract was brought in as part of the NHS's inception. This built on arrangements with general practitioners (GP's) as part of the National Insurance Act 1911. This resulted initially in 18,000 self-employed general practitioners.