The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Unified Health System. Primarily funded by the government from taxation and National Insurance contributions, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal UK residents, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).
A founding principle of the NHS was providing free healthcare at the point of use. The 1942 cross-party Beveridge Report established the principles of the NHS which was implemented by the government, whilst under Labour control in 1948 and the NHS was officially launched at Park Hospital in Davyhulme, near Manchester, England (now known as Trafford General Hospital). Labour's Minister for Health Aneurin Bevan is popularly considered the NHS's founder, despite never formally being referred to as such. In practice, "free at the point of use" normally means that anyone legitimately registered with the system (i.e. in possession of an NHS number), that is a UK resident in clinical need of treatment, can access medical care, without payment. The exceptions include NHS services such as eye tests, dental care, prescriptions and aspects of long-term care. These charges are usually lower than equivalent services offered privately and many are free to vulnerable or low-income patients.
The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 was enacted on 5 July 1948. Private health care has continued alongside the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services.
The NHS is largely funded from general taxation and National Insurance payments, fees levied by changes in the Immigration Act 2014 and a small amount from patient charges. The UK government department responsible for the NHS is the Department of Health and Social Care, led by the Secretary of State for Health and Social Care. The Department of Health and Social Care had a £192 billion budget in 2024–25, most of which was spent on the NHS.
History
A. J. Cronin's controversial novel The Citadel, published in 1937, had fomented extensive debate about the severe inadequacies of healthcare. The author's innovative ideas contributed to the conception of the NHS. Bevan commented in 1948 that "All I am doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more". This comment came from his experience of his local community healthcare provisions.R. Samuel, "North and South", London Review of Books 17.12 (22 June 1995): 3–6.
A national health service was one of the fundamental assumptions in the Beveridge Report. The Emergency Hospital Service established in 1939 provided an example of what a National Health Service might look like.
Healthcare before the war had been an unsatisfactory mix of private, municipal, and charity schemes. Bevan decided that the way forward was a national system rather than a system operated by local authorities. He proposed that each resident of the UK would be signed up to a specific General Practice (GP) as the point of entry into the system, building on the foundations laid in 1912 by the introduction of National Insurance and the list system for general practice. Patients would have access to all medical, dental, and nursing care they needed without having to pay for it. The British Medical Association initially objected to the formation of the NHS.
In 1956 the first kidney dialysis was performed. Preventing disease also became a focus, with a polio immunisation programme and another for whooping cough in 1957. 1960 saw the first kidney transplant and implantable heart pacemaker usage. In 1962 the NHS completed its first hip replacement. A measles vaccine was introduced in 1968 and the first heart transplant was at an NHS hospital. In 1979, the first bone marrow transplant was completed at Great Ormond Street Hospital.
Organisation The NHS was established within the differing nations of the United Kingdom through differing legislation, and as such there has never been a singular British healthcare system, instead there are 4 health services in the United Kingdom; NHS England, the NHS Scotland, HSC Northern Ireland and NHS Wales, which were run by the respective UK government ministries for each home nation before falling under the control of devolved governments in 1999. In 2009, NHS England agreed to a formal NHS constitution, which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service, and makes additional non-binding pledges regarding many key aspects of its operations.
The composition of the NHS has been subject to significant and repeated change since its creation, but especially from 1991 onwards following the passing of the NHS and Community Care Act 1990 and the introduction of the health service internal market. This process can be broadly divided into 3 main periods of change: from 1991 to 1997, focused on the introduction of internal market reforms and establishing the purchaser-provider split, from 1997 to 2010, when focus shifted towards patient choice and reducing wait times, and from 2010 onwards, aiming to increase local and national autonomy and integrate care across levels.
The Health and Social Care Act 2012 came into effect in April 2013, giving GP-led groups responsibility for commissioning most local NHS services. Starting in April 2013, primary care trusts (PCTs) began to be replaced by general practitioner (GP)-led organizations called clinical commissioning groups (CCGs). Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health. The Act has also become associated with the perception of increased private provision of NHS services. In reality, the provision of NHS services by private companies long precedes this legislation, but there are concerns that the new role of the healthcare regulator ('Monitor') could lead to increased use of private-sector competition, balancing care options between private companies, charities, and NHS organizations. NHS trusts responded to the Nicholson challenge—which involved making £20 billion in savings across the service by 2015.
Core principles The principal NHS website states the following as core principles:
The main aims of the additional principles are that the NHS will: Provide a comprehensive range of services Shape its services around the needs and preferences of individual patients, their families, and their carers Respond to the different needs of different populations Work continuously to improve the quality of services and to minimize errors Support and value its staff Use public funds for healthcare devoted solely to NHS patients Work with others to ensure a seamless service for patients Help to keep people healthy and work to reduce health inequalities Respect the confidentiality of individual patients and provide open access to information about services, treatment, and performance
Structure
The English NHS is controlled by the UK government through the Department of Health and Social Care (DHSC), which takes political responsibility for the service. Resource allocation and oversight was delegated to NHS England, an arm's-length body, by the Health and Social Care Act 2012. NHS England commissions primary care services (including GPs) and some specialist services, and allocates funding to 211 geographically based clinical commissioning groups (CCGs) across England. The CCGs commission most services in their areas, including hospital and community-based healthcare.
In March 2025, the government announced that NHS England would be abolished, with the provision of NHS services in England instead being managed directly by central government. The news was met with both positive comments praising the government for taking action to reduce bureaucracy, and criticism from health unions and think tanks concerned about the quality of NHS services.
Several types of organizations are commissioned to provide NHS services, including NHS trusts and private sector companies. Many NHS trusts have become NHS foundation trusts, giving them an independent legal status and greater financial freedoms. The following types of NHS trusts and foundation trusts provide NHS services in specific areas: acute trusts administer hospitals, treatment centres and specialist care in around 1,600 NHS hospitals (some trusts run between 2 and 8 different hospital sites) ambulance services trusts Care trusts, providing both health and social care services mental health trusts, specialising in managing and treating mental illness, including by the use of involuntary commitment powers
Some services are provided at a national level, including: www.nhs.uk is the primary public-facing NHS website, providing comprehensive official information on services, treatments, conditions, healthy living and current health topics Special health authorities provide various types of services
Staffing England's NHS is the largest employer in Europe, with one in every 25 adults in England working for the NHS. Nursing staff accounted for the largest cohort at more than 330,000 employees, followed by clinical support staff at 290,000, scientific and technical staff at 163,000 and physicians at 133,000.
In the year ending in March 2017, there were 1.187 million staff in England's NHS, 1.9% more than in March 2016. There were 34,260 unfilled nursing and midwifery posts in England by September 2017, this was the highest level since records began. 23% of women giving birth were left alone part of the time causing anxiety to the women and possible danger to them and their babies. This is because there are too few midwives. Neonatal mortality rose from 2.6 deaths for every 1,000 births in 2015 to 2.7 deaths per 1,000 births in 2016. Infant mortality (deaths during the first year of life) rose from 3.7 to 3.8 per 1,000 live births during the same period. Assaults on NHS staff have increased, there were 56,435 recorded physical assaults on staff in 2016–2017, 9.7% more than the 51,447 the year before. Low staffing levels and delays in patients being treated are blamed for this.
Nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals, with teams of more junior hospital doctors (most of whom are in training) being led by consultants, each of whom is trained to provide expert advice and treatment within a specific specialty. From 2017, NHS doctors must reveal how much money they make from private practice.
General practitioners, dentists, optometrists (opticians), and other providers of local health care are almost all self-employed and contract their services back to the NHS. They may operate in partnership with other professionals, own and operate their surgeries and clinics, and employ their staff, including other doctors, etc. However, the NHS does sometimes provide centrally employed healthcare professionals and facilities in areas where there is insufficient provision by self-employed professionals.