The birth of the NHS
A national health service free at the point of use? It may seem uncontentious now. But when it was proposed by Aneurin Bevan, even his Labour comrades were divided. Andy McSmith reports
Saturday 28 June 2008
On 5 July 1948, Sylvia Beckingham was admitted to hospital in Manchester to be treated for a liver condition. Doubtless this was a big event in her life; but it was an even bigger event in British history. Sylvia, 13, was the first patient to be treated on the NHS.
The idea of uniting all the country's hospitals and doctors' surgeries into one great state-run conglomerate had germinated during the Second World War, when the volume of casualties reduced the health service to near-bankruptcy. Then, Britain's 2,700 hospitals were run by charities or councils. The only people entitled to free treatment were those with jobs, but the war, and the under-investment of the pre-war years, had reduced the system to a state in which medical staff were being asked to work almost for nothing.
In 1945, the new Labour government came in on a manifesto that promised a revolution in health care. The job of health minister had been a minor one, below cabinet rank, but now it was filled by a major political player, Aneurin Bevan, the adored, charismatic leader of the Labour left. His stated ambition was to build a health service based on four principles: it was to be free at the point of use, available to everyone who needed it, paid for out of general taxation, and used responsibly.
All very uncontroversial, it might seem now, especially given the dire state of the health service at the time. Yet there was furious opposition from consultants, doctors, and the Conservative Party. Even the Labour cabinet was divided. Herbert Morrison said local councils were better qualified than the government to administer health care. That would have conflicted with Bevan's principle that the service should be universal. He was relieved and grateful when the country's biggest local authority, the Labour-led London County Council, surrendered its hospitals without a fight.
The opposition from the medical profession proved a trickier problem. Margaret Grieve, now 87, was then a new midwife working in a council-run maternity hospital in Dumfries. Yesterday she said: "On 4 July, we were congregated in the lecture room and the senior obstetrician and the matron spoke to us, and said that now we worked for Dumfries and Galloway council, but tomorrow, we'd be working for the government, but nothing would change. And for a time, nothing did.
"I was for the change because I had done my training in Glasgow where there were very poor people, and mothers who had no antenatal care. There weren't enough beds in the hospital, so most births were at home. Some of these women were afraid of the hospital, very much afraid. Often, the maternity deaths were in hospital, because the only people who came in were those who had complications, and that contributed to the fear of hospitals.
"But there was apprehension about being employed by the government. I remember the consultants talking about it. Most of them earned only a pittance from their hospital work, so they depended on private patients for their living, and they were afraid of losing that. The private patients did not want it either. But the ones coming back from the war were happy with the NHS, because they did not have the private patients."
Bevan, reflecting 10 years later on his battles, said he was blessed by the stupidity of his enemies. A favourite enemy was the secretary of the British Medical Association, Charles Hill, who would later crown his dreary career by being arguably the worst chairman the BBC ever had. Hill argued loudly that health care should be paid for from insurance, not taxation. Bevan said the rush of patients queueing for NHS treatment in the first months was partly down to the fear that Hill would get his way and the free treatment would not be on offer for long. Thus, Hill helped cement the popularity of the institution he wanted to destroy.
But the best enemy of the lot, Bevan said, was Sir Bernard Docker, a wealthy industrialist whose wife, Norah, was the greatest society celebrity of her day. Sir Bernard was chairman of a clutch of private firms, including Daimler, British Small Arms, and Westminster Hospital, and spoke for the managements of all private hospitals as chairman of the British Hospitals Association. He was the embodiment of outraged privilege, a rich man who could bear to see a penny of his wealth spent on the poor and sick. Bevan said of Sir Bernard: "Who could be luckier than that? He described the National Health Service Bill as a mass of 'mechanism in which the patient will get caught and mangled' and as providing for the 'mass murder of the hospitals'. I remember meeting a deputation led by the good knight. After listening to him and to his case I knew that the way ahead was quite clear."
Bevan could also have mentioned Lord Horder, an eminent consultant, for whom the NHS appeared to be the Spanish Inquisition reborn, to judge by the language he used to denounce it. "If medicine were taken over by the state," Lord Horder said in 1948, in a speech to the Society of Individualists, "it would be as disastrous as was the domination by the Church in the Middle Ages; a greater disaster, because the Church was cultured."
And some of Dr Hill's colleagues in the BMA thought they were fighting the Third Reich all over again. A letter in the British Medical Journal described Bevan as "a complete and uncontrolled dictator" and the doctors who had co-operated in creating the NHS were called "quislings", Quisling being the former head of the puppet government in Nazi-occupied Norway. One leading member of the BMA reckoned a nationalised health service was "the first step, and a big one, towards national socialism", in which Bevan and succeeding health ministers would fill the role of "medical Führer".
But much as he might mock, Bevan was pragmatic enough to know that he could not run the NHS without consultants, doctors and nurses. Faced with the threat of a BMA strike, he conceded that GPs would retain the freedom to run their practices as small businesses. The consultants were given more money, and allowed to keep their private practices. In Bevan's own blunt words: "I stuffed their mouths with gold." Faced with a shortage of nurses, he also pushed up their wages to attract recruits.
One of the fears underlying the Conservatives' opposition to the NHS was that when treatment was free, the feckless poor would rush in to strip the chemist shops of every pill on the shelves, then head for the dentists' surgeries to have their mouths filled with gold and silver. At first, it appeared that this might be happening. Spending during the NHS's first year vastly overshot the budget, and the prime minister, Clement Attlee, went on the radio to plead with people not to overburden the service.
The vast expense of the enterprise brought Bevan's ministerial career to a premature end. In 1951, the new Labour chancellor, Hugh Gaitskell, insisted on prescription charges, breaching Bevan's principle that care must be free. This incensed him.
Bevan had argued that the huge initial expense was the result of years of under-provision, when the dying bequeathed their spectacles to relatives who could not get prescriptions. By 1951, he had apparently been proved right, because the rush had died away, and he felt charges were a punishment unjustly imposed on patients who had behaved responsibly.
What Bevan and his allies failed to foresee was how advances in medical science would forever push up costs. After 60 years, it seems no amount of money will satisfy the infinite demand for better NHS care.
Soon after Bevan's resignation, the Labour government fell, their places taken by the Conservatives, who had opposed the creation of the NHS. Among the new Tory MPs was Charles Hill, the doctors' leader, now on the fast track to the cabinet. The issue of whether health care should be paid for out of general taxation was back on the agenda.
A Cambridge academic, Claude Guillebaud, led a committee to look at different ways to pay for the nation's health. To the government's surprise, the committee reported that the NHS was efficient, cost-effective, and deserved more money. The Tories accepted it with reasonably good grace, and did their best to forget they had ever opposed the NHS's creation. The principle of a free health service for all, paid for out of general taxation, had been won. The people had come to love their free NHS so much that no one could take it away.
Then and now: A history of the NHS
When the NHS was founded in 1948, the life expectancy for men was 66, and for women, 71. Today those figures are 77.2 and 81.5.
Over the past 60 years, the proportion of all deaths caused by cancer has risen, from 16.9 to 27 per cent. Those caused by heart disease have fallen from 35.4 to 34.6 per cent; by stroke have fallen from 11.5 to 9.6 per cent; by bronchitis and other respiratory diseases have fallen from 10.4 to 4.6 per cent; and from tuberculosis have fallen from 4.7 to 0.7 per cent.
In 1948 there were 86 deaths per 100,000 total live births. Sixty years later there are just 6.2.
When the NHS was born, there were 34.5 deaths for every 1,000 live births. Today there are just five.
The average child in 1948 would receive just two routine vaccinations: smallpox and diphtheria. By 2008 that list had grown to seven: diphtheria, tetanus, polio, whooping cough, influenza, MMR and meningitis C.
In 1948, 65 per cent of Britain's male population smoked. By 2008 that number had dropped to just 25 per cent. Among women, the figure has fallen from 41 to 22 per cent.
Bevan's creation had a total budget of £280m for the UK. In 2008, the NHS in England was allocated just £89.5m.
In 1948, £31.7m was allocated to spend on drugs. Today that figure tops £11bn.
Sixty years ago, prescriptions were free. Today they cost £7.10.
The NHS was launched with a total hospital staff of 68,013, not including doctors. In 2008 the NHS as a whole now employs more than 376,730 nurses, and thousands more doctors, healthcare assistants and ancillary staff.
In 1950 there were approximately 21,450 GPs in Britain. By last year that number had grown to 33,360.
Cost per head
In 1948 the annual cost of the NHS per head, per lifetime, was £200. Now, that figure has risen by more than 800 per cent to £1,700.
The NHS now sees and treats more patients than ever before. Last year, on an average day, 50,000 people were seen in A&E alone.
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