In the end the National Health Service choked on its own success

THE countdown to glory has begun. Fifty years ago, this country did tremendous things. It was not just that Britain won a war, although that is about to take up most of the attention. It was also that the people who actually fought or endured the war brought their victory home with them.

So I am not counting down to 8 May, VE Day, but a bit further - to 5 July, the main polling day in the 1945 general election. Nobody had the faintest idea of what was about to happen, although the Daily Mirror got it right by inspired guesswork. That day, the British elected a Labour government with a huge, even a landslide, majority. Mr Churchill got the boot, although the Potsdam Conference was only half-way through. The ruling classes ran back to their air-raid shelters, whimpering about capital levies and Bolshevism. The British were amazed at their own daring, and then deeply and rightly proud.

Out of a box of old papers last week came a leaflet I was given when I left the Forces, back in the 1950s. It was out of date even then, and the Tories were back in power. But I kept it. It was entitled "The New National Health Service, 5th July, 1948 onwards". The subheading was "What is the new National Health Service? How do you get it?"

Good plans do not always attract good words to describe them. But in this case, there was a sureness and clarity about the language of the leaflet that came straight out of the architecture of the plan itself. Government officials do not know how to write like this today. Perhaps this is because most official information is about narrowing liberties and protecting the state against the subject. Only when you broaden liberty and offer new rights can you risk plain talking.

With that in mind, the first paragraph is worth reading in full: "It [the NHS] will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a 'charity'. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness."

It seems simple. But a lot of work went into that paragraph. Its tone is not millennial, and nothing is promised about a new Homo Brittanicus of perfect physique, or even about the conquest of disease. Instead, the form - for this is really no more than a form, the preface to "the EC13 application" which had to be filled in, torn off and taken to a doctor - promises no more than "relief" from money worries. It is honest, as the warning about charges for "special items" shows. But it is composed in a powerful, rhythmic English that conveys underlying excitement. We have opened a gate into justice, over here - this way.

Under "Choose Your Doctor Now", there is an assurance that you can choose any doctor you like, and that dealings with him will be as personal and confidential as before.

"The difference is that the doctor will be paid by the Government out of funds provided by everybody." You will be "entitled" (mark that word) to "all forms of treatment in general or special hospitals, whether as an in-patient or an out-patient. These include, for instance, maternity care, sanatorium treatment, care of mental health, and all surgical operations ... Hospital charges are not payable in the new scheme. Where accommodation permits, however, you can pay something for greater privacy ..." Medicines, drugs, fillings, dentures, "appliances" and spectacles are free.

Older readers will wonder why all this once-familiar stuff needs to be repeated. Because the generation now growing up will have no idea that such a scheme for universal, equal, free health care ever existed on earth, or was conceivable - that is why! Last week, to take an example, a newspaper reported that Grampian Health Board is proposing to auction off the entire casualty and hospital services of Stonehaven to private bidders. Our children will find it normal that good health is something you buy, that expensive operations are reserved for the rich and that only the urban poor have access to free care, queuing up to get Third World basics from Mdecins Sans Frontires or the Little Sisters of Charles de Foucauld.

Under the great architecture of the NHS, however, lay assumptions about state and society that are obsolete. Again, the prose tells its own story. The leaflet sets out the new structure - the area Executive Council, the local Welfare Centre and, for the future, "special premises known as Health Centres may later be opened in your district". On "Deafness" (no silly euphemisms here), it announces: "Specialist ear clinics will be established as resources allow. At them you will get not only an expert opinion upon deafness but also, if necessary, a new hearing aid invented by a special committee of the Medical Research Council." These aids will be supplied "when ready" (the leaflet is always warning that the NHS has to start before its structure and resources are complete), "together with a reasonable allowance of maintenance batteries".

I like those italics. They suggest the inventors on that special committee toiling over their cracked white mugs of tea to perfect the People's Deaf-Aid, harrying factories to speed up production as only yesterday they harried them to produce more bomb-sights. But today that picture of "state science" leading the nation towards social justice seems remote. And that "reasonable allowance" of batteries! It is like the provision that there will be no charge for things like trusses or tin legs "unless careless breakage causes earlier replacement than usual". Who decides what is "reasonable" or "careless"? Why, we do, of course - we, the government experts.

It was, in short, pretty authoritarian. We in the Ministry know what is good for you. On the other hand, the men and women from the Ministry did know what was good for us. When I was a child, it seemed normal to me that Greenock and Port Glasgow teemed with wee men under five foot high, whose chins rested on the bar when they called for a pint of heavy. The Ministry thought it was abnormal and, by what would now be called "central government diktat", did away with it.

Centralism is not all bad. Today's NHS trust managers who deplore "central control by civil servants" are false decentralisers; all they really intend is to smash the national wage structure so that they can force nurses' pay down. Central power has its moments, and the late 1940s was one of them.

In the end the Health Service - Martin Amis's "national elf" - choked on its own success. Nobody realised that the demand for care would grow exponentially until no state on earth could finance it. In 1948, they thought public health was a plateau: you reached it, and there you stayed. The world of that leaflet cannot be restored, but - for two reasons - mourning is out of place.

First, because it is not too late. A new government can still burn the worst "market" absurdities out of the NHS, and restore that respect for the equality of human beings faced with death and pain. Second, because there is something to celebrate. The British, having beaten off Fascism, were rewarded with the most just and effective public health system the world has ever seen.

For my post-war British generation, the NHS was the main reason for feeling good about this country. Because we are bigger and stronger and live longer as a result, they can't take that away from us. It is our children we worry about.