GCSE · History · AQA · Spec 8145

Creation and development of the National Health Service

Imagine being ill and not calling the doctor because you can't pay the fee. Before 1948, that was real life for many people in Britain. So what changed?

History · Cause & effect

From paying the doctor to the NHS — and after

Tap each event, in order. Look at what led to it and what followed.

Causes ←

What led here

In 1941 the government instructed William Beveridge to report on welfare support in Britain.

Event

Beveridge Report

1942

The report argues that after the war the government should fight five giants that create hardship: want (poverty), squalor (poor housing), disease, idleness (unemployment) and ignorance (poor education).

→ Consequences

What followed

A plan for after the war: the government itself should fight hardship — disease included.
Labour promises to create a welfare state following the report's recommendations.
Watch out: Don't hunt for one single cause of the NHS. Wartime sacrifice, the Beveridge Report and Labour's popular promise all fed in — and once the NHS existed, its cost shaped everything that came after.

Before the NHS

How big was the problem?

Just before the NHS was founded, how many people in Britain had never seen a doctor?

Your estimate

10 million

0 million20 million

Before and after 1948

Before the NHSvsThe NHS in 1948

Start with the top row — it's the difference everything else hangs on.

Focus

Paying for care

Before the NHS

Doctors and hospitals often charged a fee for their services.

The NHS in 1948

Healthcare was free for all people.

The insight

This is the big one. Take away the fee and you take away the main thing that kept millions from a doctor.

Who could get treated

Before the NHS

Many people on low incomes could not afford medical care.

The NHS in 1948

Rich and poor alike — poverty could no longer stop anyone getting medical care.

What was covered

Before the NHS

Doctors and hospitals — often for a fee.

The NHS in 1948

Hospitals, doctors, dentists and opticians — all free.

Who took responsibility

Before the NHS

The patient: if you needed a doctor, you often faced a fee.

The NHS in 1948

The government: greater government investment made medical care more widely available.

The NHS since 1948

?

Reason it through

Why has it been so hard to keep NHS care free and fast for everyone?

Link 1 of 4

First link · your turn

The NHS treats everyone for free. So who picks up the bill — and what does that mean?

2
Locked — reveal the link above first
3
Locked — reveal the link above first
4
Locked — reveal the link above first

Did the NHS improve access to medical care?

Switch between the sides. Which evidence feels heavier, and why?

Access improved

Access became more restricted

Tap a claim from either side to see the evidence behind it.

Your judgement

How far did the NHS improve access?

How far did the NHS improve access to medical care in Britain? Write a short judgement (about 4–6 sentences) that uses evidence from both sides. [6 marks]

0 words · your answer stays on this page and is not sent anywhere.

WHAT YOU'VE LEARNED

A quick recap of today's lesson.

Once, seeing a doctor depended on whether you could pay. How did Britain change that in 1948 — and why has keeping the promise been so hard?

What you need to know

  • Before the NHS, doctors and hospitals often charged fees, so many people on low incomes went without care — 8 million people in Britain had never seen a doctor.
  • Wartime sacrifice, the Beveridge Report (1942) and Labour's popular promise at the 1945 election led to the welfare state, and the NHS, created in 1948, was a key feature of it.
  • The NHS made care free for everyone, but its cost led to charges from 1951 and, with huge demand, long waiting times — so access improved, but not without limits.

The big picture

Before the NHS, doctors and hospitals often charged fees, and 8 million people in Britain had never seen a doctor, mainly because they could not afford to. Wartime sacrifice built support for a welfare state, the Beveridge Report (1942) set out five giants to fight, and Labour won in 1945 promising to follow it. The NHS, created in 1948, made healthcare free for all. Its cost has since brought charges from 1951 and, with huge demand, long waits — yet because most services remain free, access has still been improved.

Key points

1A welfare state is a system in which the government accepts responsibility for protecting people's quality of life. Britain created one in the 1940s, and the NHS was a key feature of it.
2Before the Second World War, the government had already begun taking responsibility for some vulnerable groups: old age pensions (1908) and the first Ministry of Health (1919).
3Before the NHS, doctors and hospitals often charged a fee, and 8 million people in Britain had never seen a doctor, mainly because they could not afford to.
4The sacrifices of soldiers and ordinary people in the Second World War built a feeling that something new should help all people in Britain after the war.
5The Beveridge Report (asked for in 1941, published in 1942) said the government should fight five giants after the war: want, squalor, disease, idleness and ignorance.
6At the 1945 election Labour promised a welfare state following the Beveridge Report. The promise was very popular, Labour won, and between 1945 and 1951 it created the welfare state.
7The NHS was created in 1948. The Minister of Health, Aneurin Bevan, argued treatment should be available to rich and poor alike, and hospitals, doctors, dentists and opticians were free for all.
8The NHS is expensive to fund. Most services remain free, but charges began in 1951 for some treatments, including some dental and optical services, and there are prescription charges.
9Funding difficulties and huge demand (roughly 1.7 million people interact with the NHS each day) have led to long waits: almost 3 million UK patients had waited over 18 weeks at the start of 2025.

Worked example

Problem

A student writes: 'Aneurin Bevan wrote a report in 1948, and it created the NHS straight away.' Find the mistakes and rewrite the sentence so it is accurate.

⚠ Watch out

Writing that the NHS has always been completely free. Most NHS services do remain free, but charges were introduced in 1951 for some treatments, including some dental and optical services, and there are charges for prescriptions too.

🧠

Memory hook

PAY → WAR → PLAN → VOTE → NHS → BILL. People couldn't pay the doctor; the war built support; Beveridge made the plan; Labour won the vote; the NHS arrived in 1948 — and then the bill arrived, bringing charges and waits.

✓

Check yourself

Without scrolling up: put Labour's election win, the Beveridge Report and the NHS in order, with dates. Then give one sign that NHS access has become more restricted.

Flashcards

(15)
What is a welfare state?
A system in which the government accepts responsibility for protecting people's quality of life. Britain created one in the 1940s, and the NHS was a key feature of it.
Give two signs that the government was taking on welfare responsibilities before the Second World War.
Old age pensions were introduced in 1908, and a Ministry of Health was set up for the first time in 1919.
Why couldn't many people get medical care before the NHS?
Doctors and hospitals often charged a fee for their services, so many people on low incomes could not afford care.
Just before the NHS was founded, how many people in Britain had never seen a doctor — and why?
8 million, mainly because they could not afford to.
How did the Second World War encourage support for a welfare state?
Soldiers and ordinary people made difficult sacrifices for the war effort, and it was widely felt those sacrifices should lead to something new to help all people in Britain after the war.
Who was asked to report on welfare support in Britain, and when was the report published?
William Beveridge — the government instructed him in 1941, and the Beveridge Report was published in 1942.
Name the five giants in the Beveridge Report.
Want (poverty), squalor (poor housing), disease, idleness (unemployment) and ignorance (poor education).
What happened at the 1945 election?
Labour promised to create a welfare state following the Beveridge Report's recommendations. The promise was very popular, Labour won, and between 1945 and 1951 its government created the welfare state.
When was the NHS created, and what did Aneurin Bevan argue?
1948. Bevan, the Minister of Health, argued that treatment should be available to rich and poor alike.
Which kinds of care did the NHS provide free to all people?
Treatment from hospitals, doctors, dentists and opticians — so poverty could no longer stop poor people getting medical care.
What did the creation of the NHS mean for government spending on medical care?
It led to greater government investment in medical care, which made medical care more widely available.
Why were charges introduced in 1951, and for what?
The NHS is expensive to fund. Charges were introduced for some treatments, including some services from dentists and opticians.
What did a 2023 survey show about prescription charges?
10% of people with long-term medical conditions in England had skipped medication to avoid the cost of prescriptions.
Why do many people face NHS waiting times, and how bad were they at the start of 2025?
Funding difficulties and huge demand (roughly 1.7 million people interact with the NHS each day). Almost 3 million UK patients had been waiting over 18 weeks for treatment.
Overall: did the NHS improve access to medical care?
Yes. Poor people who couldn't pay fees could now be treated. Charges since 1951 have restricted access for some, but the overwhelming majority of services remain free, so access has still been improved.

Tap any card to flip it, or use Study as deck to go through them one at a time. In the full lesson these run as a spaced-repetition deck — you rate each card Hard, Good or Easy and the tricky ones keep coming back until they stick.

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