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The NHS then and now: a view from The King’s Fund’s archive

When NHS was founded in 1948, The King’s Fund had just celebrated its 50th anniversary. Needless to say, both organisations, and the health and care system, have changed considerably in the 75 years since then.

In 1948, the country was recovering from war and navigating the creation of the first national health service, and the leading causes of mortality were infectious diseases like tuberculosis. Fast forward to today, and the country is recovering from a global pandemic, demand for health services is rapidly growing with an aging population and the leading causes of mortality are non-communicable diseases like dementia and heart disease.

Despite the differences between these two periods, there are some similarities among the types of challenges we face today and back then, for example workforce shortages, supporting staff, growing waiting lists and moving care into the community. Our health and care system managed to overcome these issues 75 years go, and despite its current challenges, it now cares for more than a million people every day and has played a vital role in increasing life expectancy by 10 years since the 1940s. This means we should have confidence that the NHS is able to overcome challenges and can do so again today.

A quick dive into The King’s Fund archive emphasises that some of challenges the NHS is facing today are not unique. Here are four recommendations from 75 years ago that we can still use as inspiration to tackle the major challenges the NHS is facing today.

Workforce shortages

Then: 1948

'It is evident that the [nursing] shortage is colossal and threatens to bring down in ruins all the present effort for the extension of hospital services.'

A brief review of some of the hospital problems common to Great Britain and America

Now: 2023

There are around 112,000 unfilled posts in NHS providers

Recommendation: Some of The King’s Fund’s general recommendations in its 1948 publication on ‘hospital problems common to Great Britain and America’ are still relevant today. For example, to attract more people into nursing roles staff satisfaction needs to improve, including through more options for flexible working patterns and better-quality training. In 1948 this was about attracting young women into the working world, whereas today it’s about attracting people looking for a rewarding life-long career. And just as it did 75 years ago, the NHS is also turning abroad to recruit staff – it's no coincidence that it is also the 75th anniversary of Windrush this year.

Supporting staff

Then: 1943

‘Hospitals have a great responsibility and equally great opportunity, in relation to the care of their staff.’

Memorandum on the supervision of nurses' health : for consideration by hospitals

Now: 2023

The number of long waits increased significantly during the Covid-19 pandemic

Recommendation: The concept of staff wellbeing has changed dramatically in 75 years – NHS staff today are looking for very different things to what we describe The King’s Fund 1943 publication on the health of nurses. For example, remedial gymnastics or a precautionary X-ray to check for TB on the first day are not things commonly sought after now. However, the principles still apply – organisations have a responsibility for the physical and mental wellbeing of their staff. And organisations that look after staff will have better staff retention and better patient care.

Growing waiting lists

Then: 1954

’The total waiting lists at the end of 1951 for the 113 hospitals, amounted to 54,486 patients.’

‘These hospitals had more than 3 waiting list patients per bed.’

Hospital bed occupancy : a report of the first study group set up by the Administrative Staff Council

Now: 2023

The number of long waits increased significantly during the Covid-19 pandemic

Recommendation: The King’s Fund recommendation in 1951 was for hospitals to make better use of vacant hospital beds in neighbouring hospitals. There’s no longer a significant number of vacant beds in any hospital. However, the principle remains the same – when waiting lists are growing, systems should be using resources as efficiently as possible, including beds, diagnostic capacity and staff.

Moving care into the community

Then: 1951

‘Institutions… now protest they are having to undertake nursing duties because the hospital cannot take cases; whilst the hospitals protest equally strongly that they are having to care for patients who do not really need their services.’

The care of the aged sick : the story of an experiment in providing homes for aged patients within the National Health Service

Now: 2023

During winter a significant percentage of beds are occupied by patients with infectious diseases and patients waiting to be discharged

Recommendation: In response to the challenges in 1951, The King’s Fund experimented with opening homes for older patients who were well enough to leave hospital but still needed further support or rehabilitation before returning home. The King’s Fund is no longer a provider in this space, but health and care systems should be working towards the same ambition – to care for more patients in the most appropriate setting, which for these patients (often identified as ‘delayed discharges’ today) is in the community rather than in a hospital bed.

This quick dive into The King’s Fund recommendations from 75 years ago, hopefully shows that there is still much more we could learn from the past by asking why these challenges reoccur, and identifying which solutions were successfully implemented and which were not. Our health and care system has been overcoming challenges for the last 75 years, and with the right support, it can continue to do so.