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NHS: charging ahead with Labour?

When governments want to show they are serious about controlling welfare spending, they flirt with new charges for health care. But Labour must remember its conscience on this issue, says Charles Webster

he opening section of the famous house-to-house leaflet distributed at the inception of the NHS in 1948 proclaimed that there would be no charges, no insurance qualifications and that the new health service was not a charity.

Since the Thirties Labour had consistently advocated healthcare free at point of delivery and funded by progressive taxation.

In 1948 this principle was adopted without qualification. Indeed, it was difficult to follow any other course, since introducing charges for prescriptions, the obvious candidate for a direct charge, was impossible, since there were no such charges under the National Health Insurance system that the NHS was superseding. If the prescription charge was imposed on those who had paid their ‘stamp’ for many years, they would rightly feel cheated.

Also, since the old stamp was continued in the form of the NHS Contribution, and was expected by Beveridge to cover the cost of family practitioner services, the insured could rightly claim that introduction of the prescription charge would mean that they were paying for the service three times over, through direct taxation, through the insurance stamp, and through the direct charge.

The prescription charge therefore took on symbolic importance. It indicated the danger that a public service could be converted into a fiscal mechanism for levying a poll tax on those who had the misfortune to be sick.

As Bevan often proclaimed, this was deeply repugnant to socialist conscience. When, under pressure to cut back social services spending to support the Korean war effort, the government softened its line on health service charges, Bevan refused to comply. In his final exchange with colleagues on 9 April 1951, he insisted that ‘such charges would involve a serious breach of Socialist principles, and having on numerous occasions proclaimed in public speeches his opposition to such a course, he did not see how he could be expected to vote in favour of such a Bill’.

Bevan’s political martyrdom over health service charges has never been forgotten. Labour’s conscience has always been restless on this issue, and for a long period after the 1951 election defeat, Labour consistently pledged itself in its general election manifestos to remove health service charges. In practice this objective proved difficult to achieve, but even during the severe economic crisis of the Wilson-Callaghan administration, the prescription charge was pegged at 20p.

The 1983 manifesto reaffirmed Labour’s commitment to a ‘service free at the point of use and funded out of general taxation’. As Labour’s shadow health minister between 1983 and 1987, Frank Dobson was prominent in publicising Labour’s pledge to reduce — and eventually remove — health service charges.

For instance, just before the 1987 general election, he stated in the House of Commons on 8 April that the ‘Labour Party is opposed in principle and in practice to these charges’ and went on to promise that a Labour government would ‘substantially reduce charges upon its return to power and phase them out completely in the lifetime of the next parliament’.

Readers with long memories will also remember that Frank Dobson was at this time chair of ‘NHS Unlimited’, a pressure group established to combat the spread of privatisation in the NHS. He was also a contributor to Medicine in Society (the forerunner to healthmatters), which was active in promoting the case against both privatisation and health service charges.

The dilution of policies on health charges began in 1992, when Labour promised only to end eye and dental charges, although this was still a substantial concession. Relaunched as New Labour, the party’s long-standing commitments on health service charges were finally extinguished in 1997, when not even removal of eye sight tests for the elderly figured in the manifesto or in subsequent policy clarifications.

But even so, the 1997 manifesto retained the ‘historic principle’ that access to the NHS would be ‘based on need and need alone — not on your ability to pay’.

In the light of this assurance, revelations that Frank Dobson had succumbed to Treasury demands for reviewing a whole range of new health service charges has understandably come as a shock.

It would indeed be a great betrayal of New Labour’s manifesto commitment if the recently announced increase in resources for the NHS was immediately cancelled out by the imposition of further taxes on the sick.