Column

Look back in wonder

New Labour will learn nothing about running health services if it ignores its socialist history, warns Charles Webster

Uncritical denigration of the past is positively encouraged by the present government. The whole ethos of New Labour depends on branding itself as an entirely different product from Old Labour. Yet, when it suits its purposes, the present government borrows more from the past than it admits. One example is its flagship white paper, The New NHS, which actively borrows from Aneurin Bevan, although prudence dictates that the socialist minister’s name is not mentioned anywhere in the document.

Even statements of the government’s underlying philosophy of healthcare echo the past to an uncanny extent. Take the following guidelines for a modern health service. First, the service should ‘offer a fully co-ordinated health service, the development of social medicine in all its aspects, the linkage of environmental medicine with personal medical services, and the free availability of all medical services to all persons’. Second, ‘“co-operation” replaces “control”, “management” becomes the servant of medical science and not the instrument of bureaucracy’. Finally, health workers should be freed from their ‘present commercial relationships’ in order to ‘keep practice at the level of the rapidly advancing front of medical science’.

While you might spot some archaisms, the spirit of the these remarks is remarkably consistent with speeches made by Tony Blair and Frank Dobson when they entered office. But in fact the quotations come from the Memorandum on a National Medical Service, submitted to the coalition government in 1943 by the Communist Party. This rarely cited document was one of the best of the many rival blueprints produced during wartime preparations for a new health service. The NHS established by Bevan embodied many of the proposals of the CP memorandum, which is not surprising since many of the ideas were common to the Labour movement as a whole. It is perhaps more interesting to consider key themes in the CP document that were not taken up, yet were at the time thought essential for a health service embodying the principles cited above.

Predictably the CP pressed for full implementation of the Beveridge plan for welfare reform as its first priority. More surprising is the proposal for a national ‘Nutrition Council’ as its second priority. It was envisaged that this body would monitor and protect the nutritional standards of the whole nation. It is only now, with the establishment of the Food Standards Agency, that we are about to realise the nutritional policy advocated by the Association of Scientific Workers and Communists more than 50 years ago.

As its third priority, the CP argued that the NHS should be comprehensive and staffed on a whole-time basis. The Communists were particularly against the private practice of medicine within the NHS. As we were reminded by Laurence Pollock in the last issue of healthmatters, the NHS has grievously suffered as a result of the corrosive effects of commercialisation associated with the failure to establish the principle of whole-time service.

Strikingly at odds with trends in recent management practice was the insistence that the NHS must be managed democratically at all levels. The CP anticipated that the administrative bodies of the NHS would comprise boards of health workers and ‘the people’s representatives’.

It looked forward to a regional system of local government, which would allow for Regional Health Boards. These would be guided by Regional Health Offices, headed by medical professionals, with mechanisms for taking advice from all health workers.

For functional purposes this regional medical directorate would be split into separate departments concerned with environmental medicine, epidemiological services, hospital services, health centre services, mental health services, and industrial health services. These directorates would produce a strategic plan for healthcare for their area.

This scheme was, of course, somewhat utopian, but the CP proposal was essentially viable and indeed possesses many features worthy of revival, even though recent history has seen a steady erosion of both the regional and democratic aspects of this plan.

Finally it is worth noting that the CP looked forward to a primary care-led health service. It proposed a comprehensive system of divisional and local health centres, which would provide ‘the greater part of the personal medical services’. These should ‘develop into something more than a place where doctors will work together in groups to provide medical attention’. Their well-equipped buildings would house GPs, dentists, pharmacists, secretaries, social workers, health visitors, masseuses, nurses and midwives. These health centres would be places ‘where health education can be given, where periodic examinations of the apparently healthy population can be provided’ and they would undertake the work of the school medical service. In their developed form it was envisaged that health centres would become key elements in the social fabric of local communities.

The primary care system envisaged by the communists anticipated to a substantial degree the primary care programme that has been unfolding over the past decade, but with some important differences. For instance, the present system revolves around the independent contractor principle, which was anathema to all socialists and most planners before the NHS was founded.

Hopefully the above sketch is sufficient to demonstrate that New Labour is mistaken in severing links with its socialist heritage. Indeed, if the government is truly committed to its manifesto pledges, then it should consider whether it should be guided by the 1943 thinking of the Communist Party rather than some of the policies currently being pursued.