Birth pains of the NHS
The NHS’s inception in 1948 was plagued by political infighting and chronic shortages, says Mathew Thomson
The creation of the National Health Service – 70 years ago this month – is widely celebrated as a glorious chapter in the history of modern Britain. But, argues Mathew Thomson, a mixture of political infighting, middle-class scepticism and a chronic inability to meet demand meant that this was far from a smooth delivery
On 5 July, the National Health Service will reach its 70th anniversary. The event will be marked in a way that is extraordinary for a state institution, including ceremonies at both Westminster Abbey and York Minster. The NHS appears to have become, as former chancellor Nigel Lawson put it, something akin to a national religion. But this was a national religion with a troubled birth.
By 1946, two years before the NHS came kicking and screaming into the world, it had become clear that Britain stood on the cusp of a new era of state medicine. The National Health Service Act was pushed through parliament that year, spearheaded by the Labour government’s minister of health, Aneurin Bevan. In fact, a radical move in this direction had been difficult to hold back since the Beveridge Report of 1942 had championed the foundation of the welfare state, and a war on the “giant evils” of want, disease, ignorance, squalor and idleness. There was a degree of consensus on the need for change and, in 1944, the wartime coalition government had brought that change ever closer with a landmark white paper that proposed a comprehensive and free health service.
But beneath the calm surface lurked a considerable degree of suspicion and resistance from wide swathes of the public, many of whom baulked at the prospect of the loss of traditional medical cultures – hospitals with proud voluntary traditions and strong roots in the local community – and the meddling of an over-interventionist state. There were also significant differences between the two main political parties over what form the new health service should take. Labour’s remarkable victory in the general election of 1945 owed a lot to the feeling that it was the party more likely to push forward plans for social reform. But with the combative Bevan at the helm, the medical profession proving an obstacle, and the economic fallout from six years of war putting severe constraints on the public purse, it soon became clear that the passage towards the National Health Service wwould have to navigate choppy ppolitical waters.
This mix of optimism and aanxiety is evident in The Gleam, a West End hit written by Warren Chetham Strode that opened at the Globe Theatre in late 1946. The story begins in 1946 on the eve of the introduction of the National Health Service. Mr Cartwright, the middle-class father of a family with a history of working in medicine and a son now entering the profession, is an enthusiast, who sees the new service as a beacon of rationalisation and social progress. But when the story leaps forward to an imagined future of 1949, such hopes begin to emerge as naive. The audience are introduced to a series of shortcomings that could emerge under a system of nationalised medical care.
In particular, we enter a world in which doctors are no longer free to make decisions on purely medical grounds, and find themselves penned in by bureaucratic regulation, corrupt officialdom and political interference. As an increasingly miserable character called Dr Boyd puts it: “I’m finding it difficult to retain my own individuality as a doctor… I’m becoming a cog in a none too adequate medical machine.”
But even as the fictional Dr Boyd would surely have conceded, creating this “medical machine” was a massive challenge – one that presented its founders with the huge task of delivering a new health service free at the point of delivery to a nation in the depths of postwar austerity. That they largely achieved this is truly remarkable.
Financial collapse
The transition from a disparate collection of insurance schemes to an integrated national health service was possible because – in the case of the physical fabric of doctors’ surgeries, hospitals and public health clinics – the NHS largely took over what was there already. There were misgivings about the nationalisation of hospitals with strong local identities and links to communities through charity, but in many cases these hospitals were facing financial collapse.
However, when something altogether new was required – most notably a promised network of health centres – the result was an unmitigated failure. This was one of the most visionary aspects of the plan for a national health service, and the one that had exciting prospects in addressing health and not just illness. This had been proposed as early as 1920, and a couple of pioneering centres were built between the wars. But a combination of GP suspicion of the state and limited funds meant that development after 1948 was slow. Just 15 centres opened in the first 17 years of the new service. As for the dilapidated hospital system that the NHS inherited, it included Victorian and former poor-law
For many Britons, the advent of the NHS was confirmation of a meddling and over-interventionist state