CAMBRIDGE LETTER
Health for all
BILL KIRKMAN
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No other political initiative can claim to have transformed a nation as much as the NHS has.
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Photo: Reuters
Care when needed: NHS, A ‘cradle-to-grave’ system of healthcare.
There are few political initiatives that can be said to have transformed a nation, but that claim can be made of the British National Health Service, whose 60th birthday has just taken place. When it was introduced in 1948, Britain was in a sorry state in the aftermath of the Second World War. A legacy from the pre-war period was a system of healthcare that was a luxury, not available except in rudimentary form to the millions who could not afford to pay for medical services.
The need for reform was widely recognised. Indeed, early in the war, the national government, with extraordinary far-sighted confidence, commissioned a report into the ways in which Britain should be rebuilt after the war. It was produced under the leadership of William Beveridge, born in 1879 in Bengal, involved in mobilising and controlling manpower during the First World War, and then Director of the London School of Economics from 1919 until 1937.
The Beveridge report appeared in 1942. It recommended that the government should find ways of fighting the five “Giant Evils” of “Want, Disease, Ignorance, Squalor and Idleness”, and outlined what became known as the welfare State. When, in 1945, the Labour Party came to power, Clement Attlee, the new Prime Minister, announced that the welfare State would be introduced. It would include a National Health Service offering free medical treatment for all.
The politician most closely identified with the NHS was the Minister of Health, Aneurin (Nye) Bevan, a radical and charismatic Welsh politician, for whom the NHS was a passionate crusade.
Swathed in controversy
The passion was needed, since there was strong opposition to the idea, from the Conservative Party (by now, after the war, in opposition) and from the British Medical Association (BMA), the doctors’ professional body. The rhetoric on both sides was intemperate. A former BMA chairman, for example, likened the proposals set out in the Bill introducing the Health Service to “the first step, and a big one, to national socialism as practised in Germany”. For his part Bevan, having won the battle, made a speech on the eve of the introduction of the NHS on July 5, 1948 in which he described the Conservatives who had opposed it as “lower than vermin”.
From the vantage point of the 60th anniversary, the strength of the opposition seems scarcely credible. The NHS today faces many problems. Huge developments in medicine have taken place. There are far more, and far more expensive, drugs now available to treat diseases than existed in the 1940s. With the growth in size and sophistication of hospitals, and general practitioner practices, has come a great growth in cost.
There are well-founded criticisms of much of the bureaucracy which pervades the NHS. It sometimes seems as if the basic purpose of preventing and treating illness has been lost in a welter of complex and top-heavy management systems. And yet, no sane person — and certainly no politician wishing to retain electoral support — would dream of opposing the NHS. The arguments essentially are arguments about coping with success.
Grateful it is there
In the past three weeks I have had a direct personal reason to be grateful that the NHS exists. My 46-year-old son was savagely attacked by thugs, and needed skilled reconstructive surgery. It was provided, immediately, by highly experienced doctors, with no question of payment being required. That is the norm. Before 1948, as I well remember, it certainly was not.
Last week, the Prince of Wales attended a service at Westminster Abbey to celebrate the 60th anniversary of the NHS. During the service, a recording from a July 1949 BBC radio broadcast by Aneurin Bevan was played. Last week also, the government published a blueprint for the future of the NHS, based on a review by Lord Darzi, who is a health minister in the government and also a surgeon. He has proposed that hospitals and general practitioners’ surgeries should be given bonuses according to results, based on a variety of indicators from clinical success to patients’ satisfaction.
A different beast
It will not be straightforward. In sheer size the NHS is a monster by comparison with Nye Bevan’s 1948 infant. The pressures on it are constantly growing, not just because of the increasing sophistication which I have mentioned, but because people are living much longer (itself in great measure an achievement of the NHS).
The big difference between now and 1948 is that then the argument was about whether it should come into being. Now it is about how it should be run.
Bill Kirkman is an Emeritus Fellow of Wolfson College Cambridge, UK. Email him at: bill.kirkman@gmail.com
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