Department of english language and literature

3. The National Health Service (NHS)

3.1. History of the National Health Service

The effort to bring forward a plan for a national health service had already been discussed before the First World War. In the1920s members of the Socialist Medical Association had the idea of a national health service which should be controlled by elected local assemblies and which should work through local health centres. What was, however, different from the later ideas was the method of financing; members of the association envisaged fully salaried services. Nevertheless, their idea was never realized. Later, between the wars, there was an increased interest in solving these problems but there were no satisfying solutions. Finally, in 1947 a Labour government created the National Health Service (NHS). It was based on the report called Social Insurance and Allied Services which was published in December 1942. The report is commonly known as the Beveridge Report recommendations and its implementation would replace the previously private system of payment for health care and the voluntary system, which had not provided health facilities for all people.

Instead of being a rather technical report on social insurance, it became ‘a new declaration of human rights brought up to date for an industrial society and dealing in plain and vigorous language with some of the most controversial issues in British politics.’¹ Besides the other social reforms Beveridge recommended the foundation of a national health service. The Government accepted the Report in principle but the country could not afford to implement Beveridge’s proposals.

In 1946 there was a debate over the establishment of the NHS as well. The Opposition, the Conservative Party, elected to support the plan in principle but resisted the second reading of the National Service Bill in February 1946 because of many reasons which Sked and Cook claim:

‘it prejudiced the patient’s right to an individual family doctor, retarded the development of the hospital services by destroying local ownership, menaced all charitable foundations and weakened the responsibility of local authorities.’²

It is clear that it was very difficult for the Conservative Party. On the one hand, Conservatives knew how popular the idea of the NHS was in Britain generally. However, on the other hand, they wanted to make use of the hostility of the medical profession to the Government’s proposals.

Finally, on 5 July 1948 the National Health Service was officially established. The idea of the NHS was to provide free medical treatment both for the rich and the poor from birth to death. In other words, as is often mentioned in many books, "from the cradle to the grave" or "from the womb to the tomb". The founding principle of the NHS was not just providing treatment for those who are ill but it also to improve health and to prevent disease.

The aims of the NHS are obvious from the extract of the National Health Service Act of 1946:

1. 
   It shall be the duty of the Minister of health to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness and for that purpose to provide secure the effective provision of services in accordance with the following provisions of this Act.
   
2. 
   The services so provided shall be free of charge except where any provision of this Act expressly provides for the making and recovery of charges.³
   

The day of the establishment of the NHS (5 July 1948) brought about big changes. People started to pay collectively for medical treatment when they needed it, as taxpayers. However, there were also some contributions made from the national insurance scheme.

The NHS became an integrated and organized service which brought together hospitals, medical staff (GPs, dentists, opticians) and other services and which provided health care for the whole population.

3.1.1. Aneurin Bevan (1897 – 1960)

Aneurin Bevan, then Minister of Health must be mentioned in connection with the history of the NHS because he deserves the major credit for its foundation. He led an interesting life, full of turnarounds. When Bevan was a young man, he supported the Liberal Party but later, he converted to socialism. In 1919, Bevan started studying economics, politics and history at the Central Labour College in London. He read the Communist Manifesto and liked Marx and Engel’s ideas. In 1945, after the General Election, Aneurin Bevan was appointed as the Minister of Health by the new Labour Prime Minister, Clement Attlee. He came with a mission to change things in medical care. Firstly, he insisted on the nationalization of hospitals and secondly, he insisted on the fact that the service must cover everyone. It meant that the state and medical profession became mutually dependent, specifically that the state was dependent on the medical profession to manage the NHS. In 1948 Bevan, as Minister of Health was in charge of 2,688⁴ hospitals in England and Wales.

As the quotation below shows, Bevan was sure that it was not going to be easy but he was determined to fight for his plan which was obvious in his ‘Message to the medical profession’:

On 5th July we start together, the new National Health Service. It has not had an altogether trouble-free gestation! There have been understandable anxieties, inevitable in so great and novel an undertaking. Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others and of modern replanned buildings and equipment. But the sooner we start, the sooner we can try together to see to these things and to secure the improvements we all want . . . My job is to give you all the facilities, resources and help I can, and then to leave you alone as professional men and women to use your skill and judgement without hindrance. Let us try to develop that partnership from now on.⁵

Bevan refused the idea that doctors should be paid a full-time salaried service because the doctor’s right to reject a patient or the patient’s right to choose a doctor would not be able to function properly. Therefore, Bevan proposed, as a way of payment, the combination of a small salary and capitation fees in accordance with the number of patients on the doctors’ lists.

There were many other difficulties concerning the Conservative Opposition and its objection to the nationalization of hospitals and to the proposed decentralization of general practice. Moreover, doctors were not satisfied, and their dissatisfaction let to a professional protest. Finally, in 1948, Bevan reassured doctors by declaring that there would be no salaried services and that after three years every doctor would be free to choose if he wanted to be paid either by salary plus fees or by fee only. Bevan believed and hoped that his proclamation would ‘finally free doctors from any fears that they were to be turned in some way into “salaried civil servants” ’.⁶ Fortunately, Bevan accomplished this with great success. Research showed that the scheme started operating on 5 July 1948 among more than 20,000 GPs, which was approximately 90 per cent of total GP’s from the very beginning.⁷ 93 per cent of the population registered as patients and the scheme received enduring national approval. It was beneficial for both doctors and patients and proved to be cheaper than the critics of the scheme had predicted.

Bevan left the Ministry of Health in 1951 and for a very short time he was the Minister of Labour. He resigned because Hugh Gaitskell, the Chancellor of the Exchequer, announced that he was going to force people to pay half the cost of dentures, spectacles and prescription charges. Bevan explained his resignation in a letter to Prime Minister, Clement Attlee:

“It is wrong (to impose national health charges) because it is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world.” ⁸ Bevan, 1951

After that he became the leader of the left-wing branch of the Labour Party and he stayed as their leader for five years. In 1956, although he was already very ill, he became deputy leader of the Labour Party, but only four years later, on 6^th July 1960 he died of cancer. Because of his great contribution to the development of better medical care in Britain, Bevan is considered by many to be the most brilliant Minister of Health that Great Britain has ever had.