History of NHS – 1960-1980
1960s. Modernising Hospitals – Hospital Plan 1962
Key Events. Many of the NHS changes in the 1960s and 70s reflected the social change of time, e.g. oral contraception, and the Abortion Act (i.e. part of the changing roles of men and women in post-war society). Other important events included a Ten year plan for hospital building (Hospital Plan, 1962) and flouridation of water. Also the first coronary care units, liver and heart transplants happened.
1961 John F. Kennedy inaugurated as President of the United States
1961 Failed Cuban Invasion (Bay of Pigs)
1962 Cuban Missile Crisis
1961. Public Health. Oral contraceptive pill becomes available to many. The contraceptive pill gave women birth control, though only available to married women until 1967.
1962. Hospitals. Birth of the Modern Hospital. A “Hospital Plan for England and Wales” was proposed by Health Minister, Enoch Powell, as a ten-year vision for hospital building. 14 Regional Health Boards (RHBs) oversaw planning and building of one new DGH per 125,000 of population. This led to 90 new hospitals, with 134 extensively remodelled.
All DGHs were to have Accident and Emergency and Outpatient Departments. Single speciality hospitals went out of favour, except in London, where single organ hospitals (like the Moorfield Eye Hospital) still exist. Only people requiring specialised care, e.g. cardiac and neurosurgery, needed to travel to regional teaching hospitals, which were mostly in big cities.
1962. Management. Medical Services Review Committee’s final report (Porritt Report) – proposed a reform of the tripartite system, with the administration and co-ordination of medical and other services, under one Area Health Authority. This happened (in part), in 1974.
1962. Clinical. First Hip Replacement. John Charnley.
1963 “Sexual intercourse began in nineteen sixty-three (which was rather late for me)
between the end of the Chatterley ban and the Beatles’ first LP.”
Philip Larkin, poet
1964. Public Health. Artificial Fluoridation of Water Supply.
1963 Assassination of John F Kennedy
1963 Martin Luther King Jr. delivers “I Have a Dream” speech
1964. Clinical. First Coronary Care Unit (CCU) in UK (Edinburgh) – opened by Desmond Julian and Michael Oliver.
1964 Labour Government – Harold Wilson MP
1965. Social Care. Committee on Local Authority and Allied Social Services’ (Seebohm) Report – reported in 1968. It advised an amalgamation of welfare services, home help, mental health and social work services to create a unified social services department.
1966 Aberfan disaster, a catastrophic colliery collapse, resulted in 144 deaths
1966 England beat West Germany 4-2, wining the Football World Cup
1967 Six-Day War, a conflict between Israel and Arab states
1967. Public Health. NHS Family Planning 1967 and Abortion Act 1967 – made abortion legal up to 28 weeks (24 weeks in 1990) if a woman’s mental or physical health was at risk. The Act did not cover Northern Ireland until 2020.
1967. Public Health. Seat Belts. New cars in the UK were required to be fitted with seat belts in the front seat.
1967. Research. Whitehall Studies (large prospective cohort studies) commenced, investigating social determinants of health – specifically the cardiovascular disease prevalence and mortality rates among British civil servants.
1967. Management. Salmon Report (Senior Nursing Staff Structure) made recommendations for developing staff structure and embedding the profession in hospital management – heralding the end of the traditional matron.
1967. Management. Joint Working Party on the Organisation of Medical Work, First (Cogwheel) Report – encouraged the involvement of clinicians in management and proposed specialty groupings, e.g. medical and surgical divisions.
1968 Assassination of Martin Luther King Jr
1968 Assassination of Robert F. Kennedy
1968-80. Management. Two green papers on structural reform of the NHS – ‘Administrative structure of the medical and related services in England and Wales’ and ‘Future structure of the National Health Service in England’ proposed the creation of area authorities (enacted in 1974).
1968. Public Health. (Second) Clean Air Act 1968 introduced measures to reduce air pollution.
1968. Government. Department of Health and Social Security (DHSS). The Ministry of Health was dissolved, and its functions transferred (with the Ministry of Social Security) to the new DHSS. Twenty years later, these functions were split into: the Department of Social Security (DSS) and the Department of Health (DH), renamed the Department of Health and Social Care (DHSC) in 2018.
1968. Social Care. Health Services and Public Health Act 1968. It empowered local authorities to make arrangements to promote the welfare of old people. They were able to employ voluntary organisations to discharge this function on their behalf. Local authorities could make charges for such arrangements. However, services that fell under the NHS were excluded. This is still the case. In other words, we have an unfair system whereby, if you have a ‘medical’ cause of disability (e.g. diabetes and heart failure), the NHS pay for your long term care if needed; but if you have dementia (which is deemed ‘non-medical’), social care (i.e. council) and you will pay
1968-72. Pandemic. Hong Kong Flu. A H3N2 influenza virus spread across the world; it killed approximately one million people.
1968. Clinical. UK’s First Liver Transplant.
1968. Clinical. UK’s First Heart Transplant.
Frederick West became Britain’s first heart transplant patient in May 1968. He was the 10th patient in the world. It lasted 46 days.
1969 Apollo XI – Man first walks on the moon (Neil Armstrong and Buzz Aldrin)
1969 Concorde 001 flies for the first time, from Toulouse
1969. Management. Bonham-Carter Report. This reiterated the 1962 hospital plan’s definition of a district general hospital as a hospital that brought together a wide range of diagnostic and treatment facilities for inpatients and outpatients, but had reservations as to the population size that should be served.
1969. Government. Responsibility for the NHS in Wales was passed to the Secretary of State for Wales. The NHS in Scotland and Northern Ireland had developed separately from 1948.
The 1970s. Restructuring the NHS – NHS Major Reorganisation Act 1973
The first major reorganisation of the NHS, since 1948, occurred in 1974. Other important events included the Resource Allocation Working Party (RAWP), and GPs starting a mandatory three-year training. The first successful bone marrow transplant occurred (in a child), as did the first CT and MRI scans, and a ‘test tube’ baby.
1970 Conservative Government – Edward Heath MP
1970. Social Care. Local Authority Social Services Act 1970 carried through the recommendations of the Seebohm Report, creating a single social service department in every local authority.
1971 Greenpeace founded
1971. Government. The ‘Better services for the Mentally Handicapped‘ white paper outlined a desire to move away from caring for people with ‘mental handicap’ in institutional settings and to increase the provision of local and community care.
1971. Social Care. Attendance Allowance introduced. A non-means-tested benefit was introduced for people who had a serious or debilitating illness or disability and required personal assistance.
1971. Technology. First Computerised Tomography (CT) Scan in UK.
1972 Bloody Sunday Massacre
1972 Nixon and Brezhnev sign the SALT I Treaty
1972. Education. Royal College of General Practitioners given royal charter.
1972. Public Health. Faculty of Public Health created as standard setting body.
1972. Regulation. Report of the Briggs Committee on Nursing. This recommended there should be one national, statutory body for nurses, midwives and health visitors which should be responsible for setting standards and education and training. This happened in 1979.
1972. Government. ‘National Health Service reorganisation‘ white paper. A change of government (Conservative) and a change of secretary of state led to the white paper. This outlined significant structural and administrative reform of the health system. Interestingly, many of the proposals were carried out by Labour in 1974.
1973 Supreme Court of the United States decides Roe v. Wade
1973. Clinical. First Successful Bone Marrow Transplant in a child in the UK.
1974 Labour Government (Harold Wilson MP/James Callaghan MP)
1974 World population reaches 4 billion
1974. Government. Major NHS Reorganisation. NHS Reorganisation Act 1973 was the biggest reorganisation of the NHS in its history to that point. It abolished the 14 Regional Health Boards (RHBs), Hospital Management Committees (HMCs), and most teaching hospital boards (except those of the London postgraduate teaching hospitals). The 14 RHBs, with minor boundary changes, became Regional Health Authorities (RHAs) with a focus on strategic planning.
Operational authority was delegated from the RHAs to 90 new Area Health Authorities (AHAs), assisted by Family Practitioner Committees (FPCs) and Community Health Councils (CHCs); all coterminous with one local authority (council). This was a very good idea (which we should have stuck with!). The AHAs in turn supervised 192 District Health Authorities (DHAs).
Each AHA was responsible for 500,000-1 million people, and each DHA about 200,000 people.
Joint Consultative Committees were created between the NHS and Local Authorities, the latter providing social services, housing and education. These tried to bridge the gaps between the three domains of the original ‘tripartite system’.
FPCs were created with responsibility for GP, dental, pharmaceutical and ophthalmic services. FPCs were abolished in 1990 and replaced by family health services authorities. CHCs were created in each AHA to provide a voice for patients and the public in the NHS in England and Wales. Their work is now done by Healthwatch England.
Local authorities retained responsibility for public health measures related to food hygiene and environmental health, but preventive medical issues become the responsibility of the NHS. This returned to local government in 2013.
The Health Service Ombudsman was created – later the Health Service Commissioner of England, Scotland and Wales. The Health Service Commissioner for England still retains the post of Parliamentary Commissioner for Administration – now more commonly called the Parliamentary and Health Service Ombudsman (PHSO).
1974. Government. NHS Reorganisation in Northern Ireland. Hospitals, managed by the Northern Ireland Hospitals Authority and Hospital Management Committees from 1948 to 1974, were transferred to four integrated health and social services boards.
1974. Union. British Medical Association (BMA) – became the recognised trade union for doctors.
1975 Fall of Saigon ends the Vietnam War
1975. Public Health. Resource Allocation Working Party (RAWP) was established to distribute health funding more fairly across the UK. RAWP suggested using Standardised Mortality Ratios as a proxy for calculating regional burdens of disease. The formula devised by RAWP survived until 1989, reducing the funding gap between the Northern regions and London.
It was replaced by a more complex formula announced in the publication of ‘Working for Patients’ in 1989. There have since been further changes and debate, particularly about the relative weighting for old age which favoured the more prosperous South; whereas a model based on relative deprivation favours the North.
1975. Social Care. Social Security Act 1975 set out a range of benefits and entitlements under the social security system and introduced the Invalid Care Allowance for carers.
1975-77. Government. In her time as Secretary of State, Barbara Castle MP (for the Labour government) tried to abolish private (‘pay’) beds within the NHS. The medical profession opposed these changes and eventually the government backed down.
1975. Government. Margaret Thatcher’s choice agenda. Margaret Thatcher, then Leader of the Opposition, gave a speech to the Conservative party conference focusing on choice in health services. This set the tone for decades to come.
1976. Epidemic. First outbreak of Ebolavirus in Zaire
1976. Education. National Health Service (Vocational Training) Act 1976. GPs started a mandatory three-year training.
1976. Social Care. Integration of Health and Local Authorities – Joint Finance Programme. Government (Labour) encouraged integration of health and social care with a ‘joint finance’ programme – to further incentivise integration between local authorities and the NHS. The Joint Consultative Committees were given access to £16m to realise the vision of better integration between health and social care provision.
1977-9. Pandemic. Russian Flu. This pandemic mostly affected the population under 25 years, and resulted in approximately 700,000 deaths worldwide. It was caused by an H1N1 flu strain, like Spanish Flu.
1978. Clinical. World’s First Test Tube Baby. On 25 July, the world’s first ‘test tube baby’ was born.
1978. Research. Last Case of Smallpox in the World. The only virus eradicated from humanity through our actions.
1978. Technology. First Magnetic Resonance Imaging (MRI) in UK and World. Peter Mansfield, Nottingham.
Sir Peter Mansfield and team
1979 Conservative Government – Margaret Thatcher MP
1979. Regulation and Education. Nurses, Midwives and Health Visitors Act 1979. Provided for the establishment of a central council – Central Council for Nursing, Midwifery and Health Visiting, UKCC; responsible for education, training, regulation and disciplinary action. The Act also required the council to establish and maintain a single professional register.
1979. Government. Encouragement of the privatisation of ancillary services. The new Conservative government started to encourage the privatisation of ancillary services – such as cleaning and laundry – by sending a letter to health authorities encouraging them to tender contracts. This was a first sign of what was to come over the Thatcher/Blair years – i.e. marketisation of some aspects of the NHS.
1979 Soviet Union covertly launches invasion of Afghanistan
(This period started with Cuba, ended with Afghanistan, i.e. superpowers remain in Cold War)
Other resources
The Health Foundation have an extremely good timeline here.
The Nuffield Trust has a detailed history of the NHS here and timeline here.
The BBC has historical charts here.
