In 1911, the National Insurance Act introduced the first limited scheme of national health insurance. The Treasury appointed four Insurance Commissions (for England, Scotland, Wales and Ireland) to administer the scheme through approved societies and local insurance committees. The Commissions were not under direct ministerial control, but the Treasury ministers were responsible to Parliament for their administrative, although not the quasi-judicial, functions.
The national health insurance scheme was formally introduced in July 1912. It provided for medical benefit through attendance and treatment by medical practitioners accepting insured patients; for cash benefits for sickness, disablement and maternity; and, where surplus funds allowed, for additional benefits including specialist medical, hospital or dental treatment and skilled nursing services.
The work of the four Commissions was co-ordinated by the National Health Insurance Joint Committee, constituted as a result of the 1911 Act, who attempted to ensure uniformity between the Commissions. In 1912, the staff of the Joint Committee were merged with those of the National Health Insurance Commission for England. This subsequently undertook the work of the secretariat of the Joint Committee.
Each Commission had both central and outdoor staff, the latter consisting of an inspectorate assisted by health insurance officers and organised in England and Wales on a divisional basis. In the investigation of claims to exemption and liability, use was made of the staff of the Board of Customs and Excise, and there were also local agency arrangements with the Post Office.
The Joint Committee consisted of representatives of each Commission under a chairperson who could sit in Parliament and was in practice a member of the government. It was empowered to make any necessary financial adjustments between the funds under the control and management of the various Commissions and to regulate the valuation of approved societies in connection with the central fund of the Association of Approved Societies. It was assisted by an advisory committee appointed under the Act. The Joint Committee was incorporated by an amending Act of 1913. The original Act had given it powers to spend money on medical research, and in July 1913 it established a Medical Research Committee to administer the fund and an Advisory Council for Research to advise the Chancellor of the Exchequer; the Advisory Council did not, however, meet after 1914. In 1920 responsibility for medical research was transferred to a Medical Research Council under the supervision of a committee of the Privy Council after a brief period under the control of the Minister of Health.
The central staffs of the Commissions were administrative, financial, actuarial and medical. The Chief Actuary came to serve all the Commissions and also other government departments. In 1917 he was given the title Government Actuary, and in 1919 became the head of a separate Government Actuary's Department. Each Commission had a medical member who, together with the chief medical officer, supervised the work of the medical officers performing medical inspection duties, the appointment of medical referees and the organisation of a regional medical service. The financial staff of the English Commission were directed by a comptroller-general and its administrative staff were organised in a number of divisions: Approved Societies, Insurance Committees; Legal; Establishment and Information. During the First World War, the English Commission had the additional duty of maintaining an adequate supply of drugs and other medical stores, and it also co-ordinated the supply of doctors for the civilian population and the armed forces.
In 1919, when the Ministry of Health was established it assumed the powers and duties of the English and Welsh Commissions. These it discharged through its Insurance Department and through the Welsh Board of Health. The Irish Commission was transferred to the control of the Chief Secretary for Ireland, and in July 1919 the Scottish Commission's powers were given to the new Scottish Board of Health. Also upon the establishment of the Ministry of Health, the National Health Insurance Joint Committee was reconstituted to include the Minister of Health (as chair), the Secretary for Scotland, the Chief Secretary for Ireland, and a Welsh member appointed by the Minister. After 1922 the Irish member of the Joint Committee was the Northern Ireland Minister of Labour, though in practice each member was represented by a deputy. The Joint Committee took over from the Treasury the issue of regulations governing the administration of national health insurance, and in 1925 it became responsible for the selection of referees to consider cases of dissatisfaction with decisions by the Minister of Health on widows', orphans' and old age contributory pensions.
The Ministry of Health Act 1919 provided for the establishment by Order in Council of consultative councils in England and Wales to advise and assist the Minister. The Consultative Council on National Health Insurance was one of the four councils formed in 1919 for England, and replaced the Advisory Committee of the National Health Insurance Joint Committee. The Councils were purely advisory, but had power to initiate proposals as well as to report on reference by the Minister. The Council advised the Minister of Health in matters concerning central insurance records and the co-ordination of the approved societies who had responsibility for the collection of contributions and payment of benefits. The Consultative Council on National Health Insurance was transferred to the Ministry of National Insurance in 1945.
In 1945, on the transfer of the health insurance functions to the Ministry of National Insurance from the Ministry of Health and the Department of Health for Scotland, the National Health Insurance Joint Committee was reconstituted to represent only the Ministry of National Insurance and the Ministry of Labour for Northern Ireland. It was dissolved in July 1948 when the provisions of the National Insurance Act 1946 came into force. The approved societies and local insurance committees were also discontinued. Some of the medical functions of the latter passed to the new executive councils established under the National Health Service Act 1946, while their advisory functions in relation to insurance questions were transferred to new local advisory committees.