On the face of it, 70 years ago, the National Health Service was a crazy proposition. An insane concept by which people were suddenly given a service for free that those who could afford it had previously paid a small fortune for. Its proposal was greeted with the same scepticism that someone might receive now for suggesting we should all be entitled to free petrol, free beer, or a free haircut. There had to be a catch.
But this is essentially the idea that Aneurin Bevan proposed with his National Health Service Bill in 1946. Inspired by the Tredegar Medical Aid Society in Wales, whose hospitals committee he had served on, Bevan argued that free healthcare was uplifting for everyone and should define us as a caring nation that had just fought a war against the depravity of fascism. Moreover a healthy nation was a productive one. In real terms the NHS would pay for itself.
The Tories hated the idea. Doctors were suspicious of it. Even some of Bevan’s own party weren’t too sure about it, but 2 years later, on July 5th 1948, the NHS happened. Something that should have been impossible, became a reality. For a moment in 1948 hard-nosed politicians lost their reason and backed a colossal project that had never been tried before by any other major nation in history. Free healthcare for everyone, regardless of income, class or circumstance. A true example of socialism, putting us all on the same level of entitlement to good health.
Even patients weren’t sure what to expect from this new service. Many people in the early months were concerned about visiting the doctor in case they would eventually receive a surprise bill, or worried that the treatment would be sub-standard. After all, why would anyone give something away that had previously been so expensive?
I was born 12 years after the NHS came into being, and grew up never knowing the privation and fear that my parents and grandparents must have endured during they pre-war years. My generation never gave the NHS a second thought. It was just there. You never questioned the certainty that if you were ill, you would be treated, no questions asked.
I also remember the slow realisation in my teens that we were blessed in the country with having that option. The idea that something as fundamental as caring or concern would have a monetary value seemed anathema to my emerging social conscience. How could anyone put a price on life? Hold someone to ransom because of pain and suffering that they were enduring through no fault of their own? Watch someone die because they couldn’t pay for life saving treatment?
But the NHS itself has been on the sick list almost since its birth. The doctor’s ‘union’ the BMA voted against the idea after the passing of the bill, fearing a loss of independence and income. Bevan compromised, allowing them to keep their lucrative private work and giving GPs the freedom to run their own practices, although this didn’t sit well with him. At the time he described the deal he struck with doctors as “stuffing their mouths with gold”.
The NHS quickly became a victim of its own success.Or more accurately the lack of success of previous healthcare provision. A nation in poor health, only a year since enduring the rigours or war, rife with endemic and chronic medical conditions, fell onto the feast of opportunity offered by the NHS and almost stifled it at birth.
Only 3 years later Bevan resigned from government over the introduction of prescription charges and fees for some dental and optical treatment. He saw this as the thin end of a wedge that exposed the underlying weaknesses of the NHS which probably began with his initial compromises five years earlier.
Soon after, waiting lists were introduced which slowed the tsunami of patients to a manageable flow and added another new concept to the system. In both these moves, and in the nation’s rapacity for free care, we see the seeds of a bindweed that would eventually grow around the NHS and strangle its original concept.
Bevan’s dream for the NHS was a state funded, state administered service where doctors would be directly and exclusively employed by the service. He’d already given way to some extent on that and now saw the idea of a payment free facility also being eroded. 70 years on we can see he was right to be concerned, as successive governments, both Labour and Conservative have sought to wrangle the NHS into something controllable and constrained.
Repeated reorganisations and fudges such as PFI have gradually eroded the foundations laid by Bevan as politicians run scared of a national financial commitment they see as having no bottom.
Ultimately the Tories have begun unpicking the original concept of the NHS by introducing the so-called internal market, allowing private companies to provide services within the state system. Their Health and Social Care Act passed into law in 2012 and fundamentally broke Bevan’s bond with the nation, taking away the government’s responsibility to provide free health care to its citizens.
It’s tempting to look past the ideological rhetoric that surrounds the purity of Bevan’s ideas. The much mooted ideas of co-pay, private health insurance, payments to see your GP, the NHS contracting out services and streamlining provision, perhaps even the rationing of care based on lifestyle or genetic predisposition may seem inevitable or pragmatic as our population grows and lives longer.
But in accepting such incremental compromises we risk losing sight of the prize Bevan offered us, and to a large extent delivered into our waiting hands. His ideas weren’t based on fiscal pragmatism, financial constraint or maybe even common sense. They were founded in the idea that makes sense to every child born since 1948 – that healthcare and the freedom from pain and fear should be the right of any enlightened society regardless of cost. If we can’t rely on our government to guarantee such a basic concept, we’ve really lost our way as a nation.
The cost of the NHS is a relatively small proportion of our GDP, and as one of the richest nations on the planet we can easily afford to maintain socialised healthcare in its purest form. And no, it’s not just a matter of throwing money at the problem, but neither is it a case of cutting the funding guise of re-organisation.
I’m not much of a nationalist, but there are some things I take pride in as a Brit. One of them is that something so fundamental as healthcare, that in some other countries is so limited and unattainable by the vast majority of the population, became a universal right, virtually overnight, at a time when we’d just finished fighting a war of equally historical proportions.
The NHS was a crazy idea but it led to an achievement we should be fantastically proud of. Something of staggering cultural significance that defines us as a mature society. No matter what else we ever achieve, it should be a major part of our heritage to the world along with the dedication of the thousands of people who work within it and the millions who owe their lives to the vision of one man. We should keep that vision clear, no matter what it costs.
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