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Nye Bevan: Wrong all along? (CC 1.0)


Fed up with self-righteous junior doctors and posturing politicians? Sick of waiting months for an operation, weeks to see your doctor, or hours in A&E? Things are worse than usual this year, although the NHS has been in almost constant crisis. By the 1970s filmmakers such as Lindsay Anderson were using the NHS as a metaphor for our failing society. But count yourself lucky. The NHS is the envy of the world. Who says so? Pretty much everyone in public life since 1948, starting with Nye Bevan. He can be excused. It was his baby. The astonishing thing is that our current generation of politicians do not dare to contradict Bevan’s 70-year-old boast. In recent years they have fiddled around the fringes, ring-fencing the NHS from expenditure cuts, forcing efficiency savings, imposing  “commissioning bodies” to simulate competition, and dreaming up cut-price plans for a seven-day service. But they will not touch the fundamental monopolistic structure of the NHS, which leaves little room for genuine patient choice or provider competition.

Perhaps this ritualistic endorsement of Bevan’s creation continues because the NHS turned him from a left-wing rebel, hated at least as much as he was loved, into a national treasure. The NHS became the jewel in the crown of the Attlee government and a few years later the Conservative party, which had opposed the whole project, shamelessly changed track and has since then claimed joint parentage. Why knock a vote-winner?

So what exactly did Bevan claim to have achieved? Well, on July 4, 1948, as the NHS was being launched, he gave a definitive speech to the Labour party faithful in Manchester. As usual, Nye was more interested in triumphalist mood music than dry detail. “The eyes of the world are turning to Great Britain. We now have the moral leadership of the world and before many years we shall have people coming here as to a modern Mecca.” But there is precious little evidence of subsequent mass pilgrimages. And however much the rest of the world allegedly envied our brave new health service, not one nation of any significance turned envy into action. Pretty well every advanced liberal democracy, from Germany to Israel, from France to the Scandinavian nations, chose fundamentally different models of health provision.

Overwhelmingly they rejected our state-run monopoly — essentially the Morrisonian model in vogue when industries such as coal and rail were nationalised. Instead most other countries plumped for regulated but competing health insurance companies and non-profit agencies, local government initiatives, and religious or charitable institutions. In some, properly qualified GPs are allowed to set up shop and seek customers, just as the butcher, the baker and the candlestick maker do in this country. Most foreign planners positively encouraged the two elements which were absolutely crucial — consumer choice, and competition among providers. The NHS, in stark contrast, was designed to impede such free-market frivolities. You can “go private” but only if you are rich enough to pay twice, once in the form of the standard NHS “contribution” and again for your private insurance scheme.

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Bill Ellson
April 28th, 2016
8:04 PM
What ignorant codswallop. The establishment of the National Health Service at the end of hostilities was a wartime coalition policy agreed across parties. Following publication of the Beveridge Report in December 1942, Churchill proclaimed in his 'From the Cradle to the Grave' broadcast on 21 March 1943 "We must establish on broad and solid foundations a national health service.". Government then set to work and in March 1944 Minister of Health Conservative Henry Willink published the white paper 'A National Health Service', which contains the things that the public value about the NHS (treatment based on need, free at the point of delivery). In 1945 the majority of hospitals in England and Wales were owned and run by local government, the remainder voluntary (charitable). The 1944 white paper proposed that hospitals would be co-ordinated by groups of councils large enough to provide the full range of services. Labour policy set at the 1943 conference had envisaged hospitals staying with local gov. When Bevan's proposals to nationalise hospitals became public, local government investment and charitable donations quickly dried up. Nationalisation was opposed in Parliament by the Conservatives and in Cabinet by Herbert Morrison. (Under Morrison the London County Council had grown to become the largest health provider in England.) It was the BMA alone who opposed the principle of the NHS.

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