Data briefing: 1948: creation of a new workforce

John Appleby, Ruth Thorlby

In 1948 the NHS opened its collective doors to be faced not only with an inherited waiting list of around half a million patients and a clamour for spectacles and false teeth, but also an almost immediate staff shortage.

Publication:  Health Service Journal
Reference:  Health Service Journal, 13 March 2008

By December 1948, a shortage of nurses, affecting 'small general hospitals' and the 'female wings of mental hospitals', meant more than 53,000 beds were unoccupied through lack of staff. The Ministry of Health estimated that the NHS lacked nearly 48,000 nursing and midwifery staff - around 30 per cent of the actual numbers employed. Despite increasing the ranks of whole-time staff by over 4,000 and part-time staff by 2,250 by the first quarter of 1949, rising demand and better working conditions meant that the service was still short of 48,000 nurses. Even with higher nursing school intakes a ministry report noted that 'wastage, many due to marriage, was as great as ever'.

Reports from subsequent years show a gradual improvement in the supply of nursing and midwifery staff, but staffing in 'mental deficiency' hospitals and in midwifery was still giving 'cause for anxiety' some five years later.

While the number of nurses has increased by nearly 170 per cent since 1948, as a proportion of the total workforce they have reduced from 46 per cent to 42 per cent. Most striking, however, is the fall in the proportion of domestic and ancillary staff - from 40 per cent in 1951 to 12 per cent in 2005.

Dentists - perhaps not surprisingly given the unleashing of an enormous amount of unmet need for dental work with the arrival of a free service - were also in immediate short supply.

In 1949 there were around 9,200 dentists on NHS lists dealing with 8.5 million cases a year at the peak of demand. A shortage of supply and a fee for service payment system ensured high earnings for dentists. The ministry reported in 1949 that 'a number of dentists were earning sums very much higher than had been foreseen' and imposed an emergency check on excessive earnings in early 1949 for those earning in excess of £4,800 (equivalent to around £140,000 in 2008 prices) a year, while a new scale of fees was calculated.

Early health ministry reports seem less concerned about the overall number of GPs and more worried about whether GPs would be swamped by people with 'seemingly trivial ailments, with the risk of developing a disease-conscious frame of mind'. Happily, the government concluded in 1950 that a 'state of equilibrium' in surgery attendances had been achieved. GP numbers did not rise significantly until the 1970s.

In hospitals the medical and dental workforce - initially accounting for just under 4 per cent of all NHS employees - started increasing immediately. By 2005 the number had increased from just under 15,000 to over 100,000, doubling its share of the NHS workforce.

Concern about hospitals and staff absorbing an increasing share of the NHS budget surfaced regularly in reports, leading one author of the 1956 Guillebaud report on the cost of the NHS to conclude that the public was ultimately to blame: 'The patient and his relatives, freed from any anxiety about the cost of the treatment, welcome what they naturally regard as the superior treatment of the hospital doctors.'