Again, as in the case of the nationalization of industry, we find that much of the legislation that established the Welfare State did not spring from the bulging brows of Sir Stafford Cripps, Lord Beveridge, or Aneurin Bevan, but is the latest step in an evolutionary process. National Insurance is the logical outgrowth of the Poor Relief Act of 1601, before there were Englishmen in America, and the contributory principle on which all later measures in this field have been based first appeared in the National Health Insurance Scheme of 1912. The present system is big and it is expensive. The national and local governments are spending about £2,267,000,000 a year (about $6,347,600,000) on social services for the Welfare State, and the expenditure by the Exchequer on social services amounts to over a quarter of the total. Yet, as this is Britain where established custom dies hard, voluntary social services supplement the state services. There are literally hundreds of them, ranging from those providing general social service, such as the National Council of Social Service, through specialized organizations, such as Doctor Barnado's Homes for homeless children and the National Association for Mental Health, to religious groups such as the Church of England Children's Society and the Society of St. Vincent de Paul. The existence and vigor of these voluntary organizations testifies to the wrongness of the assumption that all social work in Britain today is in the hands of soulless civil servants. Of all the actions taken to extend social services under the Labor government, by far the most novel and controversial was the establishment of the National Health Service, which came into being on July 5, 1948. The object of the National Health Service Act was "to promote the establishment in England and Wales [other acts for Scotland and Northern Ireland came into force simultaneously] of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services." Before we consider what the service does, let us think of those it was designed to help. The British working class up to 1945 suffered to a considerable degree from lack of proper medical and dental care. Doctors and dentists were expensive, and in addition there was a definite psychological resistance to placing oneself in their care. Health and medicine were not popularized in Britain, as they were in the United States; among the poor there was still a tendency to consider discussion of these subjects as ill-mannered.