Making Integrated eCare a Reality in the UK: Past Failures, Current Successes, and Future Challenges

The Welfare State: A Labour Of Love?

The National Health Service (NHS) in the United Kingdom (UK) was launched amongst much hope and expectation in 1948, the flagship policy of the post war Labor government. In that sentence lie many of the problems that beset the NHS since its inception and continue to trouble it today. The NHS, enshrined in law by the NHS Act of 1946 (Lister 2011) was breathtaking in its scope and ambition. The Act promised that services would be provided free at the point of use, that these services would be financed from central taxation and that everyone would be eligible for care (even people temporarily resident or visiting the country) (NHS Choices 2013). This needs to be set in the context of a Britain where up to this point health care was universally paid for by the recipients, apart from in a few charitable hospitals and GP practices. This meant people often avoided visiting the doctor because they knew they would not be able to afford the treatment prescribed. If the promises of the NHS were not dramatic enough in this context, they need to be seen too against the backdrop of a country made virtually bankrupt by six years of war, where rationing was still in operation and would remain so until 1954 (Imperial War Museum 2013).

Despite these lofty and impressive ambitions, the birth of the NHS was not universally welcomed. The British Medical Association (BMA) was then, as it is now, an immensely powerful professional group representing the vast majority of both GPs and hospital doctors. It was bitterly opposed to a state run medical service and, as late as May 1948, the BMA in England voted against being a part of the proposed new service (NHS Scotland 2013). Set against them was Aneurin Bevan, the Minister for Health in the Labor government and the man charged with the responsibility of creating a national health service. It was a duty he was eager to discharge. Bevan saw the creation of a health service free at the point of need and paid for by national taxation in almost religious terms, the opportunity for ordinary working people to access healthcare when they needed it, unconstrained by financial shackles. Characteristically his book about the NHS was called “In place of fear” and in it Bevan said “No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.” (Bevan 2010)