People's History of the NHS

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The ‘Appointed Day’: Celebrated or Silent?

by Roberta Bivins

With all the tumult that continues to surround the recent EU Referendum and its results, it seems likely that yet another anniversary of the National Health Service’s first day of operation will pass with little notice this week. It is now 68 years since the National Health Service officially opened its doors on 5 July 1948, the so-called ‘Appointed Day’, designated by the National Health Act of 1946. The first NHS baby, Aneira Thomas – born at one minute past midnight on the Appointed Day in the Amman Valley cottage hospital (see its now-abandoned and decaying maternity wing here), not far from Bevan’s own birthplace in Tredegar where a workers’ health cooperative inspired the all-encompassing remit of the NHS – is now herself a pensioner, retired from a life serving the NHS as a mental health nurse. Her sisters and daughter too have lived NHS lives, working as nurses and paramedics.

As an adult, Thomas has expressed great pride in her role, her namesake, and the NHS itself. But when did her unique claim to fame become meaningful to Thomas? Interviewed in 2008, as part of the ‘NHS at 60’ celebrations, she observed that as a child, ‘I never understood what the significance of it was… I just kept saying I was the first national health baby and didn’t understand what it meant.’ And indeed, historical evidence suggests that the significance of the NHS, and thus of its annual anniversary emerged rather slowly for many patients, and service users, and for politicians, professionals and ‘media-types’, too.

Of course, in 1948 – even more than today – the residents of Great Britain faced change on an overwhelming scale. Not only the NHS but a whole raft of services, benefits, and charges came into being between 1944 and 1948: in 1944, the Education Act introduced free secondary education; in 1945, the Family Allowances Act offered families financial support while the National Insurance Act extended a benefits safety net beneath the unemployed and the sick; in 1946, the Industrial Injuries Act gave yet further benefits to those injured at work, and in 1948, the Children’s Act mandated council provision of good housing and care to all children ‘deprived of a normal home life’, while the National Assistance Act came into force, providing ‘the last defence against extreme poverty’ (in the words of the Times newspaper) in the form of benefits available to anyone in need. Whole industries were nationalized, New Towns mushroomed, and existing towns and cities saw massive building – albeit newly constrained by a tightened belt of legally-protected green land. As the Daily Mail’s editorial put it on 3 July 1948,

‘On Monday morning, you will wake up in a new Britain – in a State which “takes over” all citizens six months before they are born, provides cash and free services for their birth, for their early years, their schooling, sickness, workless days, widowhood, and retirement. Finally it helps defray the cost of their departure. … You must begin paying next Friday… Everyone, from duke to dustman, earl to errand boy, must pay, even if they decline the free services or scorn the cash allowances.’

With so many new services, and the reshaping of an entire society, it is perhaps unsurprising that the NHS Appointed Day in 1948 prompted little media fanfare; while some national and local papers carried stories announcing the ‘birth’ of the NHS, few made it front page news, or included pictures to grab readers’ attention. This was not due to any shortage of photos: as well as an extraordinary wealth of news photography documenting the day, the Ministry of Works itself generated a substantial visual archive of the new services and their staff. These are the photos with which we have now become so familiar via celebrations of key NHS anniversaries: its 50th, 60th, and 65th birthdays, for example. But almost none were published in the national press on 5th July 1948. Instead, the front pages carried the usual selection of celebrities, crimes, advertisements, ministerial handshakes and the like. In Manchester, for example, chosen as the site for Bevan’s inaugural tour of his new NHS, the city’s main newpaper gave scant coverage to local events on the day, including a large thanksgiving ceremony honouring the advent of the NHS in the city’s cathedral. It did print a picture of Bevan’s July 5th visit on the inside pages a day later — but it titled the photo ‘The Transfer of the Hospitals’, a title which emphasised loss of local control and resources rather than the advent of a new universal health service. Nor was the Manchester Guardian alone in relegating news of the ‘Appointed Day’ to its inside pages, despite praising the NHS as a symbol of ‘the advance of equalitarianism’. After all, as the paper’s editor noted, ‘the new system of social security’ provided by the Ministry of National Insurance also came into effect on the 5th, and ‘unlike … the National Health Service, will make itself felt at once’, not least through higher taxes.

The Guardian (again, like many others, including the Daily Mail at the other end of the political spectrum) marked the first anniversary of the NHS not at all. Service users, at least, certainly had good cause to celebrate: in its first year, the new NHS had provided patients with 27,000 hearing aids; 164,000 surgical and medical appliances; 6,800,000 dental treatments; and 4,500,000 pairs of glasses – and these figures did not even include items supplied through general practice, hospital dental treatments, or the hospital eye services. Ilford, a photographic supply company, even bid for an additional £1,000,000 in new capital on the back of the National Health Service’s voracious appetite for x-ray films.

However, little more than a year after its birth, the NHS was already facing criticism. For example, some complained that it was a ‘National Ill-Health Service’, too focused on ‘the free provision of corsets, free wigs, and false teeth to all and sundry’, and caring for the unhealthy ‘at the expense of the healthy’. The NHS was, according to some, already encouraging ‘social parasitism’ (Manchester Guardian, 9 August 1949). Others grumbled about ‘abuse’ of the health service by ‘foreigners’ — claims that our own on-going debates about access to the NHS echo all too accurately, of course.

Perhaps in a climate of radical social change, environmental reconstruction, anxiety and seemingly permanent austerity (yes, I am still talking about 1949 here – though viewed from the midst of our current moment of change, it may be hard to tell), the chaos was simply too great to focus on celebrating what had been achieved. Or perhaps in ‘interesting times’, the urge to cynicism, scaremongering and sometimes bitter complaint serves as a vent for wider anxieties. As the 5th of July comes around again this week, we at the People’s History of the NHS will scan the papers for clues about the current meanings of NHS anniversaries – but we won’t be surprised if comments are scanty (or negative), and celebrations muted or absent altogether.

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4 thoughts on “The ‘Appointed Day’: Celebrated or Silent?

  1. Although it seems almost unbelievable now, I think you could say the same thing about staff reactions to the NHS. Many doctors contested the terms under which the NHS was founded and the pages of Nursing Times betray a very ambivalent reaction towards the appointed day. Only trade union journals were straightforwardly positive, and even then there are no parades or rallies to celebrate “nationalisation” as there were for the coal mines.

    Definitely worth asking when and how the NHS came to be so totemic culturally!

    1. I’d be very interested to hear more about early responses to the NHS among all of the different professions and trades represented in its workforce — not least because as well as workers, they were prospective users of the services. Did that dual role affect their reactions and feelings about the NHS in its early years? Evidence from e.g. interviews and surveys of GPs in the late 1940s suggests that they, at least, found it very challenging!

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