The Herald - The Herald Magazine
Building the New Jerusalem The traumatic birth of the National Health Service in 1948
With the NHS under pressure as never before and GPs under fire, we look at how the debate over universal health care split the medical profession
IT was just after midnight on Sunday, July 4, 1948. A Glasgow doctor was still working when his night-bell rang. He opened the door to admit the patient, a woman, who apologised for the lateness of the hour. The consultation lasted a few minutes and when it was over she asked, “How much do I owe you, doctor?”
The doctor glanced at his watch. “As it’s a quarter past 12, you owe me nothing”, he said. “Had you been a little earlier the fee would have been five shillings”.
What made the difference was that the National Health Service had come into being that Monday morning. It had been a difficult and prolonged birth, after months of discussions led by the forceful, charismatic Aneurin Bevan, Clement Attlee’s Minister of Health and Housing.
“The National Health Service comes into operation this morning”, the Glasgow Herald reported that Monday, “with about 80 per cent of general practitioners in Scotland enrolled. More than 400 hospitals, with almost 65,000 beds, pass to State ownership – 183 voluntary hospitals, 218 from local authorities, and 7 which were formerly run by the Department of Health for Scotland”.
As the government had articulated it, the reasoning behind the establishment of the NHS was clear enough, the Herald added. Hospital organisations were devoid of plan or system. There was no co-ordination. There was overlapping and competition, and a lack of special services for cancer and other illnesses.
The panel doctor – a publicly remunerated GP, operating under a state health insurance scheme introduced in 1911 – was only available free of charge to insured people. If they could not afford a fee, they could only access consultant and specialist advice through the out-patient departments of voluntary hospitals.
“There was a colossal amount of unmet need that just poured in”, recalled Dr John Marks, who graduated as a doctor that Monday. As quoted on the NHS Scotland website, he added: “There were women with prolapsed uteruses literally wobbling down below their legs. It was the same with hernias. You would have men walking around with trusses holding these colossal hernias in. They were like that because they couldn’t afford to have it done”.
It’s hard to understate the lasting importance of the ‘British New Deal’ in welfare that Attlee brought about. The NHS was merely the jewel in the crown, but the discussions between Bevan and the medical profession over its establishment had been long and bitter.
As John Bew, Attlee’s latest biographer, puts it, some sections of the medical profession – notably, surgeons – were amenable to the professionalisation implied in a new national service, but others – above all GPs – were deeply resistant.
The British Medical Association, which represented GPs, was still threatening to boycott the new scheme as late as February 1948, when a nationwide plebiscite found only 4,700 GPs in favour. Most GPs, Bew says, refused to co-operate with the scheme, demanding freedom to practise in the area of their own choosing, more control over their salaries, and other employment rights, until the last few months before July 5.
“In Bevan’s view”, adds Bew, “it was only by ‘stuffing their faces with gold’ that he was able to get the doctors to acquiesce to the new system”.
Bevan had several “microscopic” [his word] meetings with BMA representatives. By late January, noting the failure of the Minister of Health and the BMA’s negotiating committee to reach agreement, the Royal Faculty of Physicians and Surgeons of Glasgow passed a resolution saying that the new service was unlikely to operate in the public’s best interests and would impair the quality of treatment.
There was crossfire, too, in the
The BMA, which represented GPs, threatened to boycott the NHS
letters page of the Herald. One reader, ‘Hillhead’, objected that a previous letter-writer, ‘Senior Consultant’, had implied gross totalitarianism on the part of Bevan’s provisions concerning doctors. Far from being totalitarian and even unfair, ‘Hillhead’ argued, the provisions were most reasonable and democratic.
Bevan’s Lochgelly-born wife, Jennie Lee, a redoubtable figure in her own right – former MP for North Lanark and, from 1945 onwards, MP for Cannock – recalled the episode in her book, My Life With Nye. Nye, she says, “had to fight all comers in order to establish” the NHS.
Though every minister had been harshly affected by the economic crisis of 1947, she wrote, Bevan had been singled out by the press. And when he was locked in discussions with the
BMA, “the violence of the attacks on him frightened some of his colleagues. They urged that more concessions be given to his critics”.
At length, however, the National Health Service Act was approved in the Commons on February 9. Bevan did not mince his words when moving the resolution. The BMA’s attitude had been a “squalid political conspiracy”.
“There has been propaganda in the newspapers supporting the party opposite [the Conservatives]”, he said, “which has resulted in grave misrepresentation as to what is in the nature of the Health Service and the conditions under which the medical profession are asked to enter it.
“There has been even worse misrepresentation, sustained by a campaign of personal abuse, from a small body of [BMA] spokesmen who have consistently misrepresented the great profession to which they are supposed to belong”.
The BMA later rejected the claim of “misrepresentation”. In the Commons, the Tories’ R.A. Butler insisted Bevan had placed the entire scheme in “grave danger”. The whole stage was set for reform; only Bevan was unprepared.
A second BMA plebiscite in May found that the majority of GPs opposed to the Act had shrunk so markedly that the BMA Council opted to advise doctors to co-operate.
Attlee’s four acts – National Insurance, Industrial Injuries,
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National Assistance, and National Health Service – were introduced on July 5. Bevan launched the NHS at the Park Hospital (now Trafford Hospital) in Davyhulme, Manchester. The night before, he stayed at the home of a local Labour politician, a Mr Rosen.
His daughter, June, quoted on the NHS70 website, recalled: “My mother said to me, ‘We’re going to take our guest breakfast in bed and you can come with me’. So we took a tray upstairs. I do remember exactly what he looked like, sitting up in his pyjamas and this shock of grey hair.
“My mother said it was the most amazing time to be involved in politics. We felt that we were going to build the New Jerusalem”.
In the hospital Bevan met the NHS’s first patient, 13-year-old Sylvia Diggory, who had a life-threatening liver condition. Later, she recalled: “Mr Bevan told me that it was a milestone in history – the most civilised step any country had ever taken”.
Speaking on the Monday, the Secretary of the Department of Health for Scotland cautioned against too much being expected in the NHS’s early days. New hospital services would be developed gradually. The main change was that all services would be free to the patient.
The previous day, Bevan had caused a stir when addressing the Manchester Labour rally. His own experiences, he said, ensured that no amount of cajolery could eradicate from his heart a deep-burning hatred of the Tory Party: “They are lower than vermin. They condemned millions of people to semi-starvation. I warn you young men and women, do not listen to what they are saying, do not listen to the seductions of Lord Woolton. They have not changed, or if they have they are slightly worse”.
“It is evident”, a Herald reader responded on our letters page on the 7th, that Bevan “himself is a very sick man.
“Deep, burning hatreds that grip the heart can be treated by psychiatrists, and who would grudge our Health Minister priority of treatment after the great strain he has been through with the more mulish members of the medical profession?”