Creating the National Health Service

Aneurin Bevan and the Medical Lords

Marvin Rintala

• Publisher: Routledge
• Year: 2004
• Print ISBN: 9780714655062
• eBook ISBN: 9781135758257
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

The origins of the NHS are the subject of this study that presents evidence on the key players who participated in the founding of the system. The author also traces those who opposed the NHS.

Part I:
Politicians Prescribe

‘I can always see a vision on the horizon which sustains me. I can see now the humble homes of the people with the dark clouds of anxiety, disease, distress, privation hanging heavily over them. And I can see, again, another vision. I can see the Old Age Pension Act, the National Insurance Act and many another Act in their trail descending, like breezes from the hills of my native land, sweeping into the mist-laden valleys, and clearing the gloom away until the rays of God’s sun have pierced the narrowest window’

David Lloyd George,
speaking at Kennington Theatre,
13 July 1912

—1—
Introduction

By one interpretation the National Health Service (NHS) was created by a national consensus within Britain. In a political system dominated by parties this view assumes that at least both of the two major British parties, Labour and Conservative, and possibly also the now minor Liberal Party, were in agreement on the essential elements of the NHS.¹ Since only the Labour Party was in governmental office during that creation, it is assumed to have been internally united behind the NHS bill introduced in 1946 by the minister of health. The opposition Conservative Party is, further, assumed to have shared in some significant way(s) in that creation. The latter argument was repeatedly and explicitly made in 1948, as the NHS was coming into operation, by the leader of the Conservative Party. Winston Churchill’s speeches then argued that the ‘main principles’ of the NHS had been ‘hammered out’ by his wartime Coalition Government before its dissolution in the spring of 1945.² Sometimes Churchill went even further, asserting that the ‘actual measure’ creating the NHS, the National Health Service Act of 1946, ‘is of course the product of the National Coalition Government of which I was the head’.³ This claim was reiterated by Churchill over the next several years.⁴ A less sweeping variation of this theme was articulated later by the Earl of Woolton, chosen by Churchill in 1946 to become chairman of the Conservative Party organization.⁵ Woolton conceded that a White Paper on health policy published in February 1944 by the Coalition Government ‘was a halfway house to the system of a nationalized service, but it was, indeed, a comprehensive one’.⁶ This more modest assertion is helpful because it links Churchill’s sweeping claim to specific events before 1945. Neither Churchill nor Woolton stressed involvement by the Conservative Party, or its leader, in the legislative process which produced the National Health Service Act of 1946.

Much more important as possible evidence for the consensual interpretation than the 1944 White Paper is the publication in late 1942 of what came to be known as the Beveridge Report on the operation of the British welfare state. That the creation of the NHS implemented part of the Beveridge Report was, and is, widely believed to be true. Since the Beveridge Report and its most important legislative predecessor, the National Insurance Act of 1911, were both Liberal documents, the now-faded Liberal Party could also share in a national consensus, in this case through time. The most important Conservative advocate of the British welfare state later sympathetically described the task of the Labour minister of health beginning in 1945 as ‘the initiation of the Health Service’, based upon the Beveridge Report.⁷ Harold Macmillan’s biographer, following his subject, repeated this argument.⁸ The assumption that in creating the NHS the Labour Cabinet and Parliament merely implemented the Beveridge Report is not confined to Conservatives. It was accepted in some of the most intellectually sophisticated circles of the Labour Party.⁹ Nor is this assumption confined to politicians. It is articulated in recent serious scholarly literature. The Act of 1946 is described as based on the ‘Beveridge model’,¹⁰ which the Labour Party ‘set about implementing’,¹¹ and as incorporating ‘the principles of the Beveridge Report’,¹² which was ‘put into effect’¹³ by the NHS Act. The Labour Cabinet ‘enacted’¹⁴ the Beveridge Report.

Perhaps revealingly, a possible alternative interpretation, that creation of the NHS flowed naturally from a long-standing explicit policy commitment of the Labour Party, appears seldom in the relevant scholarly literature. There are occasional suggestions that one or another specific aspect of the NHS had been a ‘principle of official Socialist policy’ or ‘the Labour Party’s declared policy’.¹⁵ That Labour or Conservative party members, or voters, expected, eagerly or otherwise, the Labour minister of health to introduce his radically innovative NHS bill in 1946 is, at the least, not widely argued. If that minister had merely been expressing either a national or a Labour Party consensus (or conceivably both), his bill might have been effectively representative, but hardly creative, introducing ‘little that was new’.¹⁶

As it is, the second major alternative interpretation of creation of the NHS sees the Labour minister of health, Aneurin Bevan, as the creator, working essentially alone as well as de novo, following neither a national consensus nor an established party line. Bevan himself referred to ‘my’ Health Service,¹⁷ and many others have agreed. Whether the child is seen as healthy or deformed, Bevan is in this second interpretation seen as the sole parent, responsible for ‘the inauguration of a free national health service’.¹⁸ ‘It was he who made the fundamental decisions’;¹⁹ he was ‘the founder’²⁰ of the NHS, which was his ‘creation’.²¹ He was the ‘architect’,²² who did ‘construct one of the great British institutions of the twentieth century—the NHS’.²³ That institution is seen as the Emersonian lengthened shadow of one man. As long as that institution exists, it will, according to this interpretation, be associated with Bevan’s name,²⁴ and his name will be associated with his creation, which is seen variously as his memorial, his monument, or his legacy.²⁵ That creation ‘is synonymous with Bevan’.²⁶ Because of the importance of that creation, the result of Bevan’s ‘personal intervention’,²⁷ Bevan was ‘the chief architect of Britain’s welfare state’,²⁸ which assumes there was no British welfare state before 1945. That last assumption is certainly common enough.²⁹ One future Labour prime minister saw Bevan, personally, as ‘the great innovator in health’ who also ‘triumphantly carried through Cabinet and Parliament a bold and imaginative’ bill.³⁰ The Labour Party might here be seen as an obstacle, not as an originator. To another future Labour prime minister the creation of the NHS was ‘brokered by’ Bevan’s ‘imagination’ and ‘skill’.³¹

Not all perceptions of Bevan were so favourable. In the same speeches in which he claimed credit as the true parent of the NHS, Winston Churchill blamed ‘the party and personal malignancy of Mr Bevan’ for having ‘plunged health policy into its present confusion’.³² Since the National Health Service Act was then being implemented, Churchill’s intent, if not his logic, was clear: he wished to blame Bevan while taking credit for any popular acceptance of Bevan’s act. A few days after the NHS came into operation, and also a few days after the minister of health had referred to the Conservative Party which had earlier implemented the means test for welfare benefits as ‘lower than vermin’,³³ Churchill tried to do more than blame Bevan. This time his intent was to kill:³⁴

We speak of the minister of health, but ought we not rather to say the Minister of Disease, for is not morbid hatred a form of mental disease, moral disease, and indeed a highly infectious form? Indeed, I can think of no better step to signalize the inauguration of the National Health Service than that a person who so obviously needs psychiatrical attention should be among the first of its patients.³⁵

Even though Churchill may himself here have been demonstrating ‘morbid hatred’,³⁶ Bevan, like all those who exercise power, needs to be understood, so that his act can be understood. This need exists even if a much-used textbook³⁷ is correct in arguing that the NHS ‘did not spring, like Athene fully armed, from the head of Aneurin Bevan but was a point of rapid change...

Table of contents

• Cover Page
• Half Title page
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Series Editor's Preface
• Part I: Politicians Prescribe
• Part II: Doctors Differ
• Part III: Disciples Decide
• Bibliography
• Index