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Britain – Healthcare, c.1900-48

5. Why was there no NHS before 1948?

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About this Lecture


In this module, we think about why the NHS was ‘only’ set pu in 1948, focusing in particular on: (i) the importance of the First World War in increasing government involvement in healthcare and prompting the debate about healthcare reform; (ii) the Royal Commission on the Poor Laws and Relief of Distress (1905-9), which resulted in two reports – a more moderate Majority Report and a more radical Minority Report; (iii) the plans drawn up by Christopher Addison following the First World War, and the work carried out by Lord Dawson on the viability of Addison’s plans; (iv) the political reasons why there were limited top-down reforms to healthcare in the 1920s and 30s; (v) the extent to which improvements to healthcare provision were the result of local initiatives, e.g. the Pioneer Health Centre in Peckham; (vi) the importance of local government in expanding health and welfare services, especially for women and children; (vii) the expansion of hospitals in this period, both public and voluntary; and (viii) the extent to which the patchiness of healthcare provision – the fact that some areas were served so much better than others – was the main problem solved by the NHS in 1948.


In this course, Dr George Gosling (University of Wolverhampton) explores healthcare in Britain prior to the establishment of the NHS in 1948. In the first module, we think about when the NHS began, looking at the importance of the Second World War and Labour’s 1945 election victory. After that, we consider whether there was public healthcare in Britain before the NHS, before turning in the third module to think about what private healthcare looked like prior to 1948 – a mix of businesses operating for profit but also community and charitable initiatives. In the fourth module, we think about whether people had to pay for healthcare prior to the NHS, before turning in the fifth and final module to think about why the NHS was ‘only’ set up in 1948.


Dr George Gosling is a Senior Lecturer in History at the University of Wolverhampton. He specialises in modern British history, focusing in particular on the themes of medicine, charity and welfare to explore wider questions of gender, citizenship and consumerism. His most recent book, Payment and Philanthropy in British Healthcare, 1918-48 (2017), explored the complex meanings of payment in the pre-NHS hospital. It argues that, when patient payments became commonplace after the First World War, they neither empowered consumers as hoped nor crowded out the sick poor as feared, instead they found a surprisingly traditional accommodation with the long-established class-bound principles of philanthropy.

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APA style

Gosling, G. (2021, February 02). Britain – Healthcare, c.1900-48 - Why was there no NHS before 1948? [Video]. MASSOLIT.

MLA style

Gosling, G. "Britain – Healthcare, c.1900-48 – Why was there no NHS before 1948?." MASSOLIT, uploaded by MASSOLIT, 02 Feb 2021,