Column
News from nowhere
VE day has passed, but there is more nostalgia to come. A link with an honourable past is an asset for any politician in a nation with a shabby present. The Conservatives have had their day of flag-waving and now it is Labour’s turn. What better dose of instant triumph than a strong memory of Labour’s 1945 landslide and the triumphs which followed? What better institution to cherish than Labour’s finest, the National Health Service?
Septuagenarian veterans of the campaign for the NHS will have a front rank in the politically-motivated celebrations to come. They will remind us that the health service was Labour’s creation, the envy of the world, its socialist organisation providing high quality medical care at low cost — a great leap forward for the health of the people.
Some of this is true, but much is not. Labour may have been the midwife to the NHS, but the question of its paternity is less certain. Historians of the NHS like Honigsbaum and Webster describe the pressure that arose from within the state for the formation of a coordinated medical service, and the willing acquiescence of the middle classes to abandon their expensive attachment to private practice and join the public sector. The labour movement wanted change, but was not particularly radical in its desires. Only the Socialist Medical Association, from its power base in the municipal hospitals, campaigned hard for the NHS. Ironically, the great achievement of the Labour minister of health, Aneurin Bevan, was the nationalisation of the municipal hospitals and the extirpation of local political control from the new service. The health service based on health centres that the SMA championed never left the drawing board, until revived in perverse form by fundholding.
The health service may well have been the envy of the European and North American world in the immediate post-war period, but most European countries have developed equally effective and similarly equitable medical services since.
The low cost of the NHS reflects more than the rationing performed by gatekeeper GPs. A long tradition of low pay has helped to keep the service cheap, affecting even the doctors, who earned significantly less than their European counterparts for many years. Failure to replace old hospitals or to build new health centres also contributed to the low running costs, while creating a maintenance crisis as the service outgrew its crumbling buildings. Bevan himself contributed to this, by stuffing the consultants’ mouths with gold in 1948 to buy their support. By offering them a basic salary that they could top up by competing for private practice, he set the tone for the future development of the NHS and prefigured the changes of today.
Only the last claim is true. The NHS brought medical expertise to the whole population, quickly if crudely, and (alongside free education) helped modernise British society. The great backlog of surgery not done before and during the Second World War was tackled by the early NHS, specialist services spread out from the big cities, and dentistry and ophthalmic services changed the quality of life for millions. Yet even this must be qualified. Could the NHS that Labour cherishes ever have changed enough to deliver high quality care? Whatever Labour’s public rhetoric, it must be careful to think beyond its own nostalgia.
