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Launching the new NHS – on a tight budget

Preparing for the new health service in 1948 was an uphill struggle – and even organising the publicity met with opposition, explains Charles Webster

Readers of healthmatters will not need persuading that the NHS owes a huge debt to Aneurin Bevan. After years of fruitless negotiations over a new health service, Bevan came on the scene as Minster of Heath in 1945. He evolved a new and radical plan within a few weeks of assuming office, and then successfully steered it through minefields of controversy to achieve the launch of the new service on the ‘appointed day’ of 5 July 1948. The translation of his ambitious plan from drawing board to full execution in less than three years was a remarkable achievement, with few parallels in modern social planning. On this fiftieth anniversary of the health service, it is appropriate to remember Bevan’s great personal contribution.

Most of the preparations for the new health service were an uphill struggle for Bevan and his small team of planners. The arguments with the British Medical Association are particularly well known. While Bevan’s struggles with the medical politicians and his rivals within the Labour government have been exhaustively documented, little attention has been paid to the less glamorous incidents. Bevan’s efforts to ensure that the public was properly informed about the NHS was typical of the gruelling confrontations which characterised preparations for the new service.

Battles with the Treasury to secure funds, and with other departments who were less than co-operative, meant that Bevan’s department was not able to mount a publicity campaign on the scale he had envisaged. The best-remembered effort was the 10 minute cartoon film Your very good health, featuring the problems experienced by the working class figure of Charlie and the middle-class George in coming to terms with the new service. The film was entertaining but contained virtually no practical information. Much less successful was a dry documentary film called A doctor in the house, which Bevan castigated for being boring. An expensive exhibition on the theme ‘the health of the people’ was mounted in London, but attracted little interest. A substantial booklet written by François Lafitte, a sociologist, was prepared under the auspices of the government’s Central Office of Information, but was repeatedly delayed. It was not ready by the appointed day, and was not published until a year later.

The attempts of Bevan’s team to harness the primitive public relations machinery of government to publicise the new health service risked ending in fiasco. Bevan understood the seriousness of the situation. There was a risk that ignorance and misinformation would damage the launch of the NHS and undermine its credibility in its crucial formative phase. The public had no real idea what services were to be offered, nor of the conditions for their participation. Up until the eleventh hour the enemies of the service, led by the BMA, were actively deterring their members from participation and hoping that the public would become disillusioned. The Tory press was also actively undermining Bevan’s efforts.

Ultimately, the campaign to give the public accurate information about the government’s intentions came to rest largely with a simple house-to-house leaflet distributed to all homes in the spring of 1948. This important leaflet will be reproduced in facsimile form in the next issue of healthmatters. Understandably, it was reported in December 1947 that the ‘Minister attaches very great importance to this leaflet’, and Bevan became personally engaged in the details of its drafting and production. But even this innocuous exercise was dogged by controversy.

At first the Treasury refused to pay for it, arguing that there should be a joint leaflet covering both health and social security. Bevan won the argument for a separate NHS leaflet but was forced to agree to a more economical format, leaving out diagrams or cartoons, and poorer quality paper. It was not possible to include a diagram of the new health service like that shown below which is, to my knowledge, the first effort at such a representation.

During the production and distribution stages, the Central Office of Information, HMSO and the Post Office took it in turns to be unhelpful. When 13 million copies of the leaflet had eventually been distributed, it inflamed the anger of the BMA, which accused Bevan of trying to blackmail doctors into participation in the new scheme. But by this stage the opposition of the professions was collapsing. In fact, the leaflet was perfectly timed to perform its important strategic function, and for the first time the public became fully aware of the huge benefits that were likely to flow from the new health service. The whole nation responded by uniting to signify its support for Bevan and his remarkable scheme.