In our last article about the history of health service in High Wycombe on September 21 we considered the establishment of the Health Centre on the northern outskirts of the Rye in 1938. 

The building is now used by the Busy Bees nursery. This was an initiative by the Maternity and Child Welfare Committee of the Borough Council and was funded by the local ratepayers. 

This may surprise readers, because we are so used to health care being a government responsibility funded by taxpayers through the National Health Service (NHS).

Before the NHS was created in 1948, patients were generally required to pay for their health care. Free treatment was sometimes available from Voluntary Hospitals. 

These included special hospitals providing care for particular groups of diseases and the cottage hospitals to be found in many smaller towns and villages.

Such hospitals were characterised by their independent status, were privately funded, and staffed largely by doctors and surgeons working in honorary and unpaid posts. 

They might make a small charge for treatment, the cost often being met from a health care savings plan such as those provided by a Friendly or Welfare Society.

Some more enlightened local authorities operated hospitals and other health care centres for local ratepayers (under a system originating with the Poor Law). 

Both High Wycombe and Marlow demonstrated this philanthropic spirit in the 19th century by establishing cottage hospitals. Then Wycombe went further when the War Memorial Hospital and then the Health Centre were set up. Similar moves were taking place elsewhere in the country.

Then the Local Government Act 1929 allowed local authorities to run services over and above those authorised by the Poor Law and in effect to provide medical treatment for everyone.

On April 1 1930 the London County Council (LCC) took over responsibility for 140 hospitals, medical schools and other medical institutions in the capital. 

This became the largest public health service in Britain. Throughout the 1930s pressure for reforming British health service grew and the need for a comprehensive, universal system gained support.

Prior to the Second World War there was already consensus that health insurance should be extended to the dependants of the wage-earner, and that the voluntary and local authority hospitals should be integrated. However, no action was taken due to the international crisis. 

During the war, a new centralised state-run Emergency Hospital Service employed doctors and nurses to care for those injured by enemy action and arrange for their treatment in whichever hospital was available. This began to demonstrate how a unified service might work.

The existence of this service made voluntary hospitals dependent on the Government and there was a recognition that many would be in financial trouble once peace arrived. 

The need to do something to guarantee the voluntary hospitals meant that hospital care now also drove the impetus for reform.

In October 1941, the Conservative Minister of Health in the coalition Government announced that it was proposed to ensure that a comprehensive hospital service would be available to everyone in need of it, and that local authorities would be responsible for providing it. 

The Beveridge Report of December 1942 modified this by proposing that health centres and hospitals should be run not by local authorities but by regional administrations.

Developing this into a firm policy proved difficult. The British Medical Association (BMA), who had initially supported the Government, changed policy to oppose local authority control of hospitals and of GPs working for state health centres. Instead they favoured the extension of health insurance.

Conservative MP and Health Minister Henry Willink prepared a white paper formally proposing a National Health Service. After much debate this was endorsed by the Cabinet. 

The White Paper was published in 1944 and set out the founding principles of the NHS. It was to be funded out of general taxation and not through national insurance, and services would be provided by the same doctors and the same hospitals, and:

• Services would be provided free at the point of use;
• Everyone was eligible for care (even people temporarily resident or visiting the country).

The General Election in 1945 brought the Labour Party into power, with Aneurin Bevan as Minister for Health. He decided that the 1944 White Paper’s proposal for local authority control of voluntary hospitals was not workable, as he felt that local authorities were too small to manage hospitals. 

He decided that “the only thing to do was to create an entirely new hospital service, to take over the voluntary and the local government hospitals and to organise them as a single hospital service”.

This structure of the NHS in England and Wales was established by the National Health Service Act which received Royal Assent on 6 November 1946. Bevan then encountered considerable debate and resistance from the BMA who voted in May 1948 not to join the new service. 

He brought them on board by effectively nationalising all existing hospitals, and the new arrangements were launched on 5 July 1948. However the compromise agreed with the BMA meant that from its foundation the NHS was dominated as much by hospitals as it was by doctors. 

This had one immediate and recurring consequence – the NHS became pre-occupied with curing sickness rather than promoting good health.

In Wycombe WWII had imposed a huge strain on the Memorial Hospital. An extra 34 beds were provided by the Ministry of Health at a cost of £896. This increased the capacity to 96 beds. 

Voluntary Agencies such as the British Red Cross, St John’s Ambulance and the Women’s Voluntary Service continued to play an important role. 

In its final annual report in 1947 the Hospital Committee looked back with pride on the achievements of the voluntary hospital, the Chairman saying: “As we bid farewell to the old order let us welcome in the new and wish God- speed to those who will endeavour on its behalf.”

With the formation of the NHS on July 5, 1948 the War Memorial Hospital came under the jurisdiction of the High Wycombe & District Hospital Management Committee, which was responsible to the Oxford Region Hospital Board.