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Where is Labour’s vision for the NHS of 1997?

In 1945, Labour’s modernising and egalitarian vision for a National Health Service helped to win the election. In 1997 the vision seems to have faded badly, says Charles Webster

October’s political conferences provided the last opportunity for the rival political parties to air their health policies before they enter the general election campaign. It is difficult to avoid the conclusion that, despite its extravagant rhetoric about preparing our institutions for the next millennium, New Labour has little to offer that is different from the policies adopted by the present government. Notwithstanding marginal differences of bias, it is evident that Labour has been largely won over to the Conservative position in the course of its long period in opposition. The policy agenda has been set by the Tories rather than New Labour.

History suggests that Old Labour used its lengthy period in opposition rather better. Starting from slender roots, during the Depression Labour built up a comprehensive programme for socialised medicine, which effectively determined the course of preparations for the NHS during World War II. As the junior partner in the coalition, with the health portfolio in Conservative hands and the BMA and its allies vigorously opposed to socialised medicine, Labour was only able to influence the 1944 white paper, A National Health Service,to a very limited extent.

Labour rejected the compromises of the white paper, at one stage even threatening to bring down the coalition over the issue, a serious prospect in the middle of a world war. But this indicated the seriousness of Labour’s commitment to comprehensive reform of healthcare. In the period between the white paper and the 1945 general election, the two main political parties further diverged over health policy. In a vigorous parliamentary debate, Edith Summerskill denounced Conservative health policy for perpetuating obsolete methods of organising treatment, the effect of which would be ‘to uphold the charitable system, to thwart the brilliant young doctor without capital, and to preserve the privileges of those who make fortunes out of the ill-health of the workers’.

Labour sharpened up its commitment to socialised medicine, and this was confirmed at its annual conference, held on the eve of the 1945 general election. The relevant resolution, supported by the National Executive Committee, proposed:

• to constitute local authorities as statutory health authorities retaining direct control over municipal hospitals and responsible for a comprehensive health service. It was anticipated that local government would be reorganised on a regional basis to constitute units suitable for health administration.
• to end the ‘panel’ system of general practice and ensure that doctors would be distributed according to the needs of the population, with the abolition of the buying and selling of practices, and provision by local authorities of improved practice centres.
• to provide a comprehensive and free system for training of all classes of health worker, guaranteeing equal opportunities for women.

In its health document prepared for the election, Labour promised that ‘in the new National Health Service there should be health centres where the people may get the best that modern science can offer, more and better hospitals, and proper conditions for our doctors and nurses. More research is required into the causes of disease and the ways to prevent and cure it’.

With hindsight, Labour’s vision for healthcare is open to objection, but for its date it was challenging and innovative. It was certainly more impressive than anything available to the electorate previously. These conclusions were shared by the voters; health policy contributed its share to the impressive electoral mandate received by Labour in 1945.

Inevitably New Labour must frame its policies in the light of the challenges of the 1990s but, despite the opportunities created by 16 years in opposition and all the superior forces of experience and expertise at his disposal, Mr Blair and his team have notably failed to generate anything like the forward-looking programme adopted by Old Labour in 1945. At least as far as its health policies are concerned, the electorate could be forgiven for regarding New Labour as little more than Old Conservative writ large.