Bevan and the NHS

Conservatives NHS history

Nye Bevan’s creation of the British NHS in 1948 has to be one of the greatest achievements by any single politician. The list of formidable opponents he had to take on is impressive, but he prevailed.

At its creation he famously warned that “The NHS will last as long as there are folk left with the faith to fight for it”.  Few compromises were made , but as early as 1951 he had already resigned over the introduction of dental and spectacle charges.

In 1952 he produced a collection of essays “In Place of Fear”.  His warnings 63 years ago are as relevant today.

Ironically those opposed to the NHS have taken Bevan’s advice.

“No political party would survive that tried to destroy it”

“No government that attempts to destroy the Health Service can hope to command the support of the British people”.

“They knew the Service was already popular with the people. If the Service could be killed they wouldn’t mind, but they would wish it done more stealthily and in such a fashion that they would not appear to have the responsibility”.

Perhaps the first organized ideas to get rid of the NHS came from Arthur Seldon , one of Thatcher’s heros, in his 1968 book “After the NHS” published by his creation , the Institute of Economic Affairs.  The plot evolved further in Thatcher’s time and has been carried forward by the Neo-Liberal policies of all British Governments since. Health is a multi-trillion dollar business for exploitation , not a service.

So , as Bevan stated in 1952…

“The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health”.

“Powerful vested interests with profits at stake compel the public authorities to fight a sustained battle against the assumption that the pursuit of individual profit is the best way to serve the general good”

“A free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst”.

“a public undertaking of this magnitude is big business. It touches trade and industry at a hundred sensitive points”.

For these reasons  the NHS needed to be destroyed in a devious secret way, and because profit and big business over-rides Bevan’s higher moral values…..

“no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means”.

“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide”.

“The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged”.

Bevan was proud of the…

“massive contribution the British Health Service makes to the equipment of a civilized society. It has now become a part of the texture of our national life”.

….a texture that is being destroyed.

He predicted , correctly, how the dismantling would happen

“Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine”.       

So we see the attacks on foreigners , NHS staff including doctors and nurses, and a daily menu of anti-NHS stories, where apparently the NHS is to blame for the failure of Government to have sensible public health policies. Lack of staff, poor performance and governance issues are the NHS’s fault , not Government. Even funding is now not the Government’s fault. It appoints a man (Simon Stevens) who says the service needs £x and so the Government pretends to give £x.

Bevan’s arguments for free treatment for foreign visitors are the same today , and perhaps more persuasive as the Country is much richer now than in the aftermath of the World War.

 “One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous”.

“The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together”.

But this Government are to devise ways of distinguishing “the sheep from the goats” and with help from the right-wing press greatly exaggerate the cost to con the public. They ignore both generosity and convenience in pursuit of their ideology.

Bevan tackled the elephant in today’s room and that is the conflict of  money interfering with clinical decision making. Well before Blair introduced “Payment by Results” Bevan had this to say…

“Neither payment by results nor the profit motive are relevant”.

“In claiming them, capitalism proudly displays medals won in the battles it has lost”.   

“Danger of abuse in the Health Service is always at the point where private commercialism impinges on the Service; where, for example, the optician is paid for the spectacles he himself prescribes, or the dentist gives an unnecessary filling for which he is paid. Abuse occurs where an attempt is made to marry the incompatible principles of private acquisitiveness with a public service”.

“They are silent where economies could be made at the expense of profits”.

And the consulting room is being polluted by rationing , financial spreadsheets and biased clinical decision-making despite Bevan’s warning…

“The consulting room is inviolable and no sensible person would have it otherwise”.

Other ways of funding are back on the (secret) agenda. Bevan considered many methods and dismissed all but state funding.

 “Some American friends tried hard to persuade me that one way out of the alleged dilemma of providing free health treatment for people able to afford to pay for it would be to ‘fix an income limit below which treatment would be free while those above, must pay. This makes the worst of all worlds. It still involves proof, with disadvantages I have already described. In addition it is exposed to lying and cheating and all sorts of insidious nepotism.

And these are the least of its shortcomings. The really objectionable feature is the creation of a two-standard health service, one below and one above the salt. It is merely the old British Poor Law system over again. Even if the service given is the same in both categories there will always be the suspicion in the mind of the patient that it is not so, and this again is not a healthy mental state”.

But today this is being pushed forward and again with the “help” of some American “friends”

Breaking up the NHS and “devolution” is happening despite Bevan’s warnings…

 “no local finances should be levied, for this would once more give rise to frontier problems; and the essential unity of the Service would be destroyed”.

His other great adversary was of course the BMA…

 “But the hardest task for any public representative charged with the duty of making a free Health Service available to the community is overcoming the fears, real and imaginary, of the medical profession”

“…the propaganda of the British Medical Association, which warned the people at one time that, although they would be paying their contributions, the Health Service would not be there to meet their needs”

“In dealing with the medical profession it is wise to make a distinction between three main causes of opposition to the establishment of a free National Health Service. There is the opposition which springs from political opinion as such. This is part of the general opposition of Conservative ideas, and it is strong in the medical profession, though the expression of it tends to be supercharged with the emotions borrowed from other fears and ambitions. Second, there is the defence of professional status and material reward. The latter, of course, they share with other pressure groups. Then, thirdly, there is the opposition which springs from the fear that lay interference might affect academic freedom and come between the doctor and his patient”.

They warned that doctors would be made into civil servants, there would be no free choice of doctor and

socialized medicine would destroy the privacy of doctor-patient relationship

“The BMA refused…a graduated system of capitation payments (which) would have discouraged big lists”

…..a system it eventually accepted. .They claimed the “independence of medicine is at stake”, and voted 9:1 against the Act. It was said this was the “first step, and a big one, towards National Socialism as practiced in Germany”.  The BMA have re-written history and now claim to have been in support of the NHS.

The Government and Jeremy Hunt in particular would be wise to recognize Bevan’s views on GPs….

 “I have a warm spot for the general practitioner despite his tempestuousness   The family doctor is in many ways the most important person in the Service. He comes into the most immediate and continuous touch with the members of the community. He is also the gateway to all the other branches of the Service”

And how much is now devoted to administration ?

The separate expenses of the bodies engaged in the administration of the British National Health Service amount to about 3 per cent of the total sum spent

It was no more than 4% until the introduction of the market and now the commercialization of the NHS has increased this to at least 16%. When the U.S system is properly established it will rival their 36%.

Bevan not only achieved the creation of one of the institutions that help define our nation , but one that the British people claim to be most proud of.

He knew and predicted the threats to its existence from the outset.   In “In Place of Fear” he tried to warn us all.     Have we let him down ?