The Beginning of Something Bigger
When the NHS was born on 5 July 1948, it brought with it a promise: healthcare for all, free at the point of use. It was a bold and radical idea, introduced through the National Health Service Act of 1946 by Aneurin Bevan. The aim was simple but revolutionary — to provide a comprehensive health service for everyone, regardless of income. Bevan believed that no one should be denied care because they could not afford it.
But alongside that promise came a quieter revolution. One that involved paintbrushes, gardening tools, knitting needles, and the belief that purposeful activity could heal. This is the story of occupational therapy in the NHS. And for me, it is also the story of my family.
A Brief History of Occupational Therapy in the UK
Occupational therapy has deep roots in the UK, grounded in the belief that engaging in meaningful activity can support health and recovery. Its origins trace back to the late 18th and early 19th centuries, when the moral treatment movement began using purposeful activity in asylums to support mental wellbeing.
In 1925, Margaret Barr Fulton became the first formally trained occupational therapist in the UK. Just five years later, in 1930, Dr Elizabeth Casson opened Dorset House in Bristol the UK’s first school of occupational therapy. Her vision helped shape the profession into what it is today: creative, compassionate, and grounded in everyday life.
When the NHS was launched in 1948, occupational therapy became part of the new national health system. Since then, the profession has grown and evolved, expanding into hospitals, mental health services, schools, community care, and specialist areas such as dementia, autism, palliative care, and rehabilitation.
Today, occupational therapists work across the lifespan and in every corner of health and social care. We help people do the things that matter to them, not just to survive, but to live well.
A Legacy of Care in my Family
I am a second-generation occupational therapist. My mum, born just a year before the NHS, qualified in 1980 and spent her career helping others heal through activity. She retired as the lead AHP for a mental health and learning disability NHS trust. Even now, she continues to serve as a governor of an NHS trust. That sense of service runs deep in our family.
I know I get my passion for service and love of occupational therapy from my mum. But I also get my passion and skills for writing from my dad.
This morning, I texted him to say I was writing a blog to celebrate the NHS turning 77 today. Within two hours, he sent me this:
“I am 72 years old, so the NHS, at 77, has been with me all my life. I have been fortunate enough not to have required its services very often during these 72 years, so it was a surprise to me to have a recent diagnosis of bowel cancer. This came following the bi-annual stool test, which was confirmed by a colonoscopy. A week or so after the colonoscopy I had a letter from my GP surgery offering support following my recent cancer diagnosis.
This was a bit of a shock, because my overoptimistic reading of what the doctor had said to me immediately following the colonoscopy was that they had found something suspicious and had taken a sample to be tested. I had assumed that the test results would be needed to ascertain whether or not the sample was cancerous. However, when I called the GP surgery to query the letter, I had a call back from one of the GPs at the surgery who explained that the letter that he and I had received from the hospital meant they were almost certain that the cancer was present. But, my GP reassured me, ‘This has been caught early. I know other patients who have had a similar experience and have had a full recovery. This is an example of the testing and early diagnosis system working as it should.’”
“This has proved to be the case, because, despite a delay due to the discovery of an enlarged thyroid gland, seven weeks after the initial diagnosis, I have had surgery to remove a section of the sigmoid colon and am at home with little pain or discomfort. I was in the hospital for five days. The surgery was semi-robotic, making several small incisions, most of which are now almost invisible. My four days recovering in a small bay of four beds allowed me to reflect on the care I and the other patients there were receiving. The staff were busy, but attentive when they needed to be. I was particularly impressed with the patient, calm and respectful way that the staff cared for the man in the bed next to me who was clearly distressed and needed constant help with his toileting. He was embarrassed about this but was constantly reassured that he was not a nuisance, that this was their job, that they understood his problems and were there to help him.”
“The surgical team met me prior to the operation and afterwards. They calmly explained what they intended to do and why this was necessary. Whilst I was recovering, I met them two or three times and they offered reassurance that the operation had gone well and encouraged me to get moving as soon as I could, as this would aid recovery. I have followed this advice.”
“This has been an interesting experience for me. I had no symptoms, was fit and well as far as I knew, regularly walking, cycling and playing badminton. The NHS discovered I had a problem, which, if left untreated, would cause me considerable harm and they have successfully removed it. This has been my first significant interaction with the NHS for my own medical needs. No doubt the operation and subsequent care will have cost thousands if not tens of thousands of pounds, though of course it may have saved a far more expensive intervention and care had it been left until symptoms emerged. As my GP had said to me in that initial phone call, this is an example of the system working well.”
“When the NHS was founded in 1947, the average life expectancy for men in the UK was 66 years. Now it is 79. Clearly one of the reasons, alongside improved diet, less dangerous jobs, improvements in public health, and reduced levels of smoking, for this change are the services provided by the NHS, such as the early diagnosis and treatment of bowel cancer. But this improvement in life expectancy alongside the development of new treatments means that the demands on the NHS are ever increasing. The longer we live, the more we need treatments for illnesses that come with old age. Like all large organisations the NHS is bureaucratic and cumbersome at times, but for me it worked well. If we want it to be there for all of us we need to accept that it will be expensive for us, the residents of the UK, and we need to be prepared to pay for it. I have always supported the principles on which the NHS was founded, to provide a service free at the point of need, for everyone. It may have its faults and can be improved, but we should never forget how well it works for most of us, as it did for me.”
His words speak for themselves. They are a reminder that the NHS is not just a system. It is a lifeline, a safety net, and a source of dignity and care.
A Family Affair
I FaceTimed my mum this morning. She has been retired for ten years now, but her connection to the NHS and to occupational therapy is still strong. I asked her what she loved most about the NHS. She said, “Despite all its problems, the NHS is always there for you when you need it.” When I asked her what she thought the biggest challenge was for occupational therapists, she said, “We worry too much about people not understanding what we do. I never worried. I just showed them.” That is something I am still learning from her.
It is not just me and Mum. My brother and sister-in-law are both NHS dietitians staff. I FaceTimed them too much earlier than they would have liked. They were a bit grumpy about the early call, but they humoured me. I asked them the same two questions.
What do you love about the NHS? One of them joked, “The salary pays the mortgage.” But then they got serious. “It is a crucial part of British culture. It is the backbone of our society. Quote direct from by brother “Nye Bevan is my hero and if you cut me I bleed the Bevridge report” – He has a particular senses of humour
What are the biggest challenges for your profession? “Funding,” they said. “We are an underfunded profession. And there is so much misinformation online. People giving dangerous dietary advice without qualifications. That is a real risk to public health.”
These conversations reminded me how deeply embedded our family is in the NHS, and how much we all care about its future. The recently published NHS 10-Year Plan sets out a bold vision for transformation. It focuses on three major shifts: moving care from hospital to community, transitioning from analogue to digital systems, and shifting the focus from treatment to prevention (Department of Health and Social Care, 2024).
Occupational therapists are central to delivering this vision. We already work in communities, support digital access to care, and focus on prevention every day. But as we move forward, we must not lose sight of what makes our profession unique.
As the World Federation of Occupational Therapists puts it, occupations are “the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do” (WFOT, 2012).
That is the heart of our work. And it is what makes occupational therapy essential to the future of health and care.
As Occupational Therapist – We Must Not Lose Sight of Our Core
As we step into this new era of transformation, occupational therapy must not lose its core focus on occupation. It is what makes us unique. It is what makes us effective. It is what people need, support to do the things that matter most to them, in the places they live, with the people they love.
When my dad reflected on his experience, he mentioned that he had not really needed the NHS until now. But what kept him well for so long were the occupations he enjoyed. Cycling, walking, playing badminton. These are not just hobbies. They are the everyday activities that give life rhythm, meaning, and connection.
Key to this, and something that is sometimes missed by policymakers, is that occupation is not just about productivity or independence. It is about identity, wellbeing, and belonging. It is about engaging in the things we need to do, want to do, and are expected to do. When people cannot do those things, other services may help with symptoms or support needs. But it is occupational therapy that helps people reconnect with meaning.
Some people, like my dad, can return to those occupations without intervention. But for many of the people I work with in mental health services, this is the ultimate challenge. There are often barriers to engagement that go far beyond individual control. Poverty, stigma, trauma, housing, or systemic inequality. That is where occupational therapy becomes not just helpful, but essential.
As the Royal College of Occupational Therapists states, “Occupational therapists are uniquely placed to help people take part in activities and routines, occupations, that support their health and wellbeing” (Royal College of Occupational Therapists, 2024).
And as the World Federation of Occupational Therapists reminds us, occupations are “the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do” (WFOT, 2012).
More Than a Job
The NHS is one of the few health systems in the world that is truly free at the point of need. From cradle to grave, it is a constant presence in our lives. For my family, it has been everything. The place we work, the system that supports us, and the safety net we turn to when life gets hard.
It has helped us build careers, pay mortgages, and stay alive. Through it all, occupational therapy has been our healing craft.
As the NHS marks its 77th birthday, this is more than just a celebration of a health service. It is a celebration of the people, the professions, and the purpose that keeps it going. For us, it is a moment to reflect on what the NHS has given, what we have given back, and why we must continue to protect and invest in it. Because for many of us, like my family, the NHS is not just where we work. It is where we live our values.
References
- Department of Health and Social Care (2024) Fit for the Future: NHS 10-Year Plan for England. Available at: https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future(Accessed: 5 July 2025).
- Royal College of Occupational Therapists (2024) Occupational therapy and mental health. Available at: https://www.rcot.co.uk/explore-resources/children-young-people-families/ot-mental-health (Accessed: 5 July 2025).
- World Federation of Occupational Therapists (2012) Definition of Occupational Therapy. Available at: https://wfot.org/about/about-occupational-therapy (Accessed: 5 July 2025).