70 years of NHS funding: how do we know how much is enough?

In his landmark 1942 report, William Beveridge said that a comprehensive health service would “diminish disease by prevention and cure”1 and that costs would consequently be relatively stable. This optimism was unfounded, and vast unmet need took doctors and policy makers by surprise in the early days of the NHS. The first winter crisis was in 1948, and substantial overspends in the NHS’s first two years alarmed the Treasury. Responses included introducing user charges for optometry and dentistry, which prompted Aneurin Bevan’s resignation, and commissioning the Guillebaud committee to investigate NHS costs. “Rolling crises”2 have characterised debate about NHS funding ever since, often accompanied by lobbying not just for increased spending but for increased user charges and diversity of funding streams.3 There is no right answer to the level of NHS funding, but we can approach the debate in several ways.