For reference, please visit: https://p4h.world/en/universal-object-country/united-kingdom | Maps are an approximation of actual country borders.

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

Aneurin BevanMinister of Health 1945-51

Pre-1911 GROWING ROLE OF THE STATE IN SOCIAL PROTECTION

1598 & 1601 1848

Public Health ActLegal recognition of the State’s

duty for disease prevention. Contributes to wave of

public health infrastructure investment over following

years.

1834

Second Poor LawsState takes over responsibility for administering relief for the

poor from the church.

First Poor Laws‘Right to relief’ for vulnerable

groups, including basic medical care, funded via a

progressive tax administered by church parishes.

1911 - 1939 COVERAGE FOR WORKERS AND PATCHING UP THE GAPS

1911 1929

Local Government ActPermits Poor Law institutions

to be taken over and converted into municipal general

hospitals. The State takes on a major role as a provider of

health services.

1920s & 1930s

Increasing, but sporadic, public investments in free or

subsidized health services for various diseases and

vulnerable groups.

National Insurance ActSocial health insurance

scheme covering nearly half of adult population. Includes primary care and drugs but not hospital treatment or

dependents.

The NHS achieves high levels of public satisfaction and is one of the features of British society that makes its citizens most proud. However the work of universal health coverage is never complete, especially for countries like the UK that share an understanding of the concept not as providing some minimum basic safety net for the poorest, but “universalizing the best”.

In the coming years there will be further debate on the role of government, optimal system of administration and adequate funding of the NHS, as well as the extent of the universal benefit package (e.g. whether it should extend to social care). Supporting these efforts in an era of medical advances, rising chronic diseases andageing populations takes continued work to improve and refine health systems, as well as constant political engagement to advance the mission of the NHS through good times and bad.

OUTLOOK

1939 - 1975

1939 19461941

The Beveridge ReportCalled for a tax financed

national health service, free at the point of use, as part of the wider establishment of a comprehensive welfare state.

Emergency Hospital ServiceWartime service established

to care for casualties, veterans and other groups,

demonstrating the potential benefits of a publicly funded,

centrally controlled health system.

CREATION AND CONSOLIDATION OF THE NHS

National Health Service Act

Establishes the world’s first universal, free at the point of use health system in England and Wales, with the State as dominant purchaser and – for hospitals – provider of care.

Equivalent legislation passes for Scotland in 1947 and Northern Ireland in 1948.

1956

Mental Health ActIntegrates mental health

services as a core part of the NHS mandate, benefit package

and administration.

1973

NHS Reorganization ActConsolidation of health

powers, with community care, school health, ambulances and public health responsibilities

all moved from local authorities to the NHS.

1975

Resource Allocation Working Party Report

Used econometric methodsto demonstrate for the first

time the inequitabledistribution of health spending

nationally. Introduced a weighted population formulawhich is used to equalize this

over the next decade.

1976 - 2020

1990 20021998

National Institute for Clinical Excellence (NICE) createdIntroduces a transparent

process by which the NHS will decide which new treatments should be provided for free.

NHS and Community Care ActCreates an ‘internal market’ by separating out the NHS’s duties as payer and provider

to different agencies. Scotland and Wales would subsequently

reverse this change.

THE QUEST FOR HIGH QUALITY CARE FOR ALL

2012

Health and Social Care ActMajor structural reorganization

of the English NHS, to create a quasi-autonomous payer agency ‘NHS England’, and

handing local commissioning responsibilities to groups of

local family doctors.

Wanless ReviewBegins a five-year period of

unprecedented spending growth to reverse under-

funding of the NHS, financed in part by a rise in taxation.

2019

NHS Long Term PlanRolls back much of the recent

trend towards competition within the English NHS in favour of Integrated Care

Systems of local payers and providers working together.

UK PUBLIC HEALTHCARE FINANCING: 1900 - 2020

This card was created in friendly collaboration with Jonty Roland, Independent Health Systems Consultant

UNITED KINGDOMEVOLUTION OF UHC IN THE

of Great Britain and Northern Ireland

NATIONAL UHC DYNAMICS CARDwww.p4h.world

towards SDG 3.8.2

GENERAL INFORMATIONThe National Health Service (NHS) was founded in 1948 and remains the dominant system of health coverage in the UK. It is financed primarily through general taxation, with separate models of administration across England, Scotland, Wales and Northern Ireland.

While the NHS built on many previous reforms to increase coverage and affirm the state’s responsibility for the right to health, when the NHS Act was passed in 1946 the UK was the first country to introduce a truly universal system, free at the point of need.

Every UK resident is entitled to care funded by the NHS, which includes a broad benefit package, covering most primary, secondary,

tertiary, community and mental healthcare treatments.

In terms of provision, most hospital, ambulance, mental health and community care providers are owned by the state, although in England around half have been awarded ‘foundation trust’ status, which gives them a degree of autonomy from central control. Most general practices are independent private providers operating under nationally agreed contractual terms.

Countries learning from each other to achieve and maintain Universal Health Coverage (UHC)