Health Check: The NHS At 60

5th July 2008

The National Health Service, now on the cusp of its 61st year, is continually derided by press and politicians alike… too bureaucratic, unable to deal with so-called hospital superbugs, ill-equipped to deal with the demands of patients and the increasingly ageing population.

Jack Johnson looks at the history of the NHS, and considers what factors may have damaged this British institution – and why its health, well-being and very existence should not be taken for granted.

Before the Beveridge Report of 1942 (commissioned by the wartime coalition government headed by Winston Churchill), free comprehensive healthcare for all had never been proposed by those in political power. Certainly, Britain had introduced a welfare system under the Liberal government of the early 20th century, but this had comprised only state pensions and national insurance. Basic health was still the responsibility of the individual.

Though it is hard to put a positive spin on any war – especially one in which such huge numbers died, were injured or lost their homes – the Second World War did create a sense of British ‘togetherness’. Class differences began to fade away as everyone pulled together: rich or poor, north or south, all faced the threat of Nazi bombs.

In the midst of the war, then, the government was already beginning to plan for life after the conflict, a life in which there would be a range of needs to be met.

William Beveridge – noted economist and liberal – was commissioned by Arthur Greenwood, Labour MP and Minister without Portfolio, to chair an inter-departmental committee survey of Britain's incoherent, irregular welfare provision, and to make recommendations for change. The committee concluded that the five giants to be tackled on the road to Britain’s future post-war reconstruction were ‘want, disease, ignorance, squalor and idleness’; and that policies of social security ‘must be achieved by co-operation between the state and the individual, with the state securing the service and contributions’.

The Beveridge Report (‘Social Insurance and Allied Services’) proved immensely popular with the public. A fortnight after its publication, the British Institute of Public Opinion found that 95 per cent of the public had heard of it and that ‘there was overwhelming agreement that the plan should be put into effect’. The Conservative party would not commit to the principles set out by Beveridge, but the Labour Party made it a major part of its next manifesto – which resulted in an electoral landslide victory in 1945.

Though Arthur Greenwood and William Beveridge were both important in laying the foundations of the welfare state in general, and the NHS in particular, Aneurin ‘Nye’ Bevan is undoubtedly the father of the institution. The plain-speaking Welsh socialist, and Minister for Health in Labour’s post-war administration, believed that everybody should be looked after by the State ‘from cradle to grave’, with free diagnosis and treatment for all. (In fact, so incensed was Bevan by the decision in 1951 to bring in charges for glasses and dental care to fund Britain’s involvement in the Korean War, that he resigned from the government.)

As the NHS marks its 60 years, having been created on 5 July 1948 at the Park (now Trafford General) Hospital in Manchester, it certainly does have a fair degree of problems, attributable to lack of sustained government investment and structural meddling by those in political power. This started under the Margaret Thatcher administration (1979 -1990) and continues under Gordon Brown’s beleaguered Labour government today.

The 1980s saw the introduction of general managers in the NHS, replacing the previous system of consensus management. This period also saw what was known as the internal market, where Health Authorities ceased to run hospitals but ‘purchased’ care from their own or other authorities’ hospitals. Arguably, both these major changes made the NHS more bureaucratic while decreasing the quality of patient care.

More recently, the New Labour Governments (1997 - present) have encouraged the outsourcing of medical services and heavily supported the use of the private sector, including PFI schemes. The New Labour party has supported the so-called independent sector with taxpayers’ cash in order to facilitate a steady stream of off-sheet public sector investment while also allowing Gordon Brown to keep within his self-imposed spending limits.
But New Labour’s public/private sector compromise has had its share of drawbacks. According to a 2002 study by a consultancy company which worked for the Department of Health, every £200 million spent on these privately financed hospitals will result in the loss of 1,000 doctors and nurses. The first PFI hospitals contain some 28 per cent fewer beds than the ones they replaced.

Structural and spending issues have weakened the NHS over the years, but it remains free at the point of need. At present. According to a British Medical Association poll of nearly a thousand young GPs and hospital doctors in April 2007, 61 per cent thought patients would have to pay for some treatment by 2017. So even the next generation of medical professionals strongly doubts how long the NHS can maintain its core principle of universal healthcare coverage.

Watching filmmaker Michael Moore’s documentary, Sicko (2007), however, you realise that we Brits do take the NHS very much for granted. Moore highlights how the USA – the world’s richest country – has a costly paid-for insurance-only healthcare system. Sadly 47 million people (16 per cent of the US population) just cannot afford health insurance coverage; the poorest members of society simply have to go without life-saving treatment or long-term care.

The National Health Service does remain public for now – although its creeping privatisation continues, and is likely to increase further under a future Conservative government. Though weakened over the years by many and various political meddlers, the institution carries on maintaining the principle of collective universalism. In the face of government cutbacks to all public services, we need to make a stand to save our NHS, which ‘we’ all fund and thus collectively ‘own’. As the great Nye Bevan once put it, “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means”.

Plan for social security:

Medical treatment covering all requirements will be provided for all citizens by a National Health Service organised under the health departments and post-medical rehabilitation treatment will be provided for all persons capable of profiting by it.

Extract from the Report to the Parliament on Social Insurance and
Allied Services (The Beveridge Report) 1942.

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