Letter: The struggle for the NHS

No one under retirement age can remember health in Britain before the NHS. Such as it was, the service consisted of a mishmash of provisions a little like that in the USA today.

People in salaried employment paid into health insurance. There were independent hospitals, funded by charity, including sending nurses out collecting on ‘flag days’. GPs charged for services and for prescriptions, as did dentists and oculists. The National Insurance Act of 1911 had provided for ‘panel patients’. Men and women in work could receive free medical treatment, but not their families and the service was often second class. Anyway, fewer than half the country’s medical practices had signed up to this system. This was the patchwork system that the Labour government of 1945 inherited.

Aneurin Bevan, known to all except his enemies as Nye, and named after the sixth century Welsh poet, was born and brought up in the mining town of Tredegar at the head of the Sirhowy Valley in South Wales. Leaving school at 13, he went down the mine, and soon became head of his Miners Lodge. A spell at the Central Labour College in London led to three years unemployment back in Tredegar.

Rising through the ranks of the labour movement, he became the member of parliament for the constituency that included Tredegar in 1929 and was one of the most fiery and left-wing Labour MPs. During world war two he was the most vocal critic of Winston Churchill and an obvious candidate for the cabinet after Labour’s election landslide in 1945.

When Nye was growing up in Tredegar, the Tredegar Workingmen’s Medical Aid Society looked after the health of the 20,000 people in the local area. For a very small weekly payment it provided a hospital, a central surgery, five doctors, two dentists and support staff, all free to people who needed them. This was the model that Nye saw for a new national health service when Clement Attlee made him Minister of Health in 1945.

Nye’s plan was to ‘Tredegarise’ Britain, providing a national healthcare system free to all, paid for out of general taxation. But he first had to face down opposition in his own party.

Herbert Morrison, deputy prime minister (and the grandfather of Peter Mandelson), wanted a system controlled and financed by local authorities. This was, of course, open to variation from town to town, with Tory-controlled councils most likely cutting back on services. Bevan won that argument but went on to face major opposition from the press, the Tory Party, and the British Medical Association (BMA), which claimed to speak for doctors.

The publication of the plan was met with a bombardment of opposition in the national press. The charge was led in parliament by Winston Churchill who accused Bevan of taking the first step from a national service to a National Socialist (ie Nazi) government.

The most serious opposition came from the BMA – the doctors organisation. The head of the BMA, an arch Tory, declared that doctors opposed the NHS ten to one. But many doctors, especially in working class areas, were in favour, telling stories of people not getting treatment because they could not afford it.

One told of treating a child hearing their sister upstairs screaming with pain but being stopped from going up to her by their mother because she could not afford to pay. Dr Julian Tudor Hart, a doctor in a Welsh mining valley and a strong supporter of Nye’s, coined the ‘Inverse Care Law’ – to the extent that health becomes a commodity, it becomes like champagne. The rich get lots and the poor don’t get any.

Bevan was forced to compromise. Doctors remained independent, receiving a payment from the state per patient, and consultants were able to continue treating private patients. In Bevan’s smiling words “I bound their mouths with gold”.

The National Health Service opened on 5 July 1948. From that date all medical treatment was free, as were dentistry and optical aids. In the beginning there were huge queues for all sorts of treatment, especially dentistry. The Tories and their press portrayed this as a result of greed on the part of the masses. In fact, of course, it was just a result of the huge pent up need from people who had never been able to afford decent healthcare in their lives.

Sadly Labour’s reforming zeal ran out. In 1950, under pressure from the US government, they started a rearmament programme. To pay for this it was proposed to start charging for medical prescriptions. Bevan saw this as breaking one of the basic promises of the NHS and resigned from the government. He spent the rest of his life on the back benches and died in 1960.

Nye would have been angered but not surprised by the privatisation policy of the Tory government, and angered by the feeble response of Labour. But in the 1990s, Tony Blair, as Labour prime minister, spelt out clearly that the NHS “must develop the acceptance of a more market-oriented approach”, moving towards “becoming a regulator rather than a supplier”, and moving away from the ethos of public service, in other words privatisation (see New Labour’s Real NHS Legacy by John Dale, in Socialism Today No.238, May 2020).

So, for example, in 2005 NHS Logistics – the integrated system of purchasing, stockholding and distribution – went to DHL, the courier company. Certainly the amount of money spent on the NHS went up under New Labour, but much of the increase went into the pockets of private shareholders.

Strongly opposed to any moves in the direction of Welsh self-determination, Nye would have been nonplussed by the fact that while prescription charges in England have risen to nearly £10 a piece, prescriptions in Wales are free. But Welsh Labour has only put up a feeble opposition to Tory measures, with no out and out campaign of opposition.

What is required is a campaign to return the NHS to public control, removing the private companies and, in the bargain, nationalising the huge pharmaceutical companies which leach on our service.

Geoff Jones, Swansea

In memory of Kate Jones (1953-2021), lifelong socialist and staunch defender of our NHS.