NHS at 70: Morgan Daniels looks behind the myth and finds our rulers conceding to an emboldened working class
[T]he Palace is unsafe if the cottage is unhappy.
Benjamin Disraeli, 1872
When and why does the ruling class cede reforms beneficial to the worker? As we approach the seventieth anniversary of the National Health Service, the central plank of a postwar ‘deal’ in Britain comprising a welfare state, a commitment to full employment, and a mixed economy, it is worth asking this question with force.
But halfway through the second world war, in November 1942, the British coalition government published Social Insurance and Allied Services, a report drafted by William Beveridge, a Liberal economist, surveying the state of the country’s social welfare and providing recommendations for the immediate future. The Beveridge Report, as it became known, was hardly a fudge: ‘A revolutionary moment in the world’s history is a time for revolutions, not for patching’ reads a famous line in its introduction. A few sentences later, Beveridge outlined the five key ‘giants on the road to reconstruction’ that would need to be conquered: Want, Disease, Ignorance, Squalor, and Idleness.
The report provided a blueprint for tackling each of these ‘giants’ in the postwar world, one more-or-less adopted wholesale by the Labour Party in their manifesto for the 1945 general election, which they won with a majority of over 150. What followed was a fairly radical reconstellation of a society under great stress. With Clement Attlee as prime minister, Labour introduced not only the NHS, but also provided, through the 1946 National Insurance Act and the 1948 National Assistance Act, a far-reaching system of social security. The Attlee government also oversaw a sustained programme of nationalisation: the Bank of England; Cable and Wireless; the steel and coal mining industries; Britain’s railways and canals; and basic utilities, such as electricity and gas, had all come into public ownership by 1951.
A revolutionary moment! Quite the language for a government report! What’s really going on here?
When the findings of the Beveridge Report were debated in parliament in 1943, the young Tory MP Quintin Hogg (later Lord Hailsham) despaired at some of his colleagues who were unwilling to adopt widespread welfare reform after the war. In one memorable exchange, he seemingly channeled Disraeli, as above: ‘Some of my hon. Friends seem to overlook one or two ultimate facts about social reform. The first is that if you do not give the people social reform, they are going to give you social revolution.’ He sounded the alarm further: ‘Let anyone consider the possibility of a series of dangerous industrial strikes following the present hostilities’.
In 1943 no less than in 1872, talk of revolution was hardly out of place. As the second imperialist world war of the twentieth century raged, the end of the first would still have been a pronounced memory: in 1919, 35 million days were ‘lost’ to strikes (compared to six million in 1918), with armed servants of the state — soldiers, sailors, and the police — leading the charge. (A general strike, seven years later, lasted for nine days and involved 1.7 million workers.) Following the 1929 Wall Street Crash, meanwhile, unemployment figures surpassed 3 million nationally. Was not the Beveridge Report itself, then, precisely the type of ‘patching’ required by the British state to stymie a ‘revolutionary moment’, Beveridge almost sanctioning revolution in a bureaucratic register?
‘Irrespective of what particular political party was in power,’ wrote Kwame Nkrumah, first prime minister of Ghana, ‘the internal pressures in the rich countries of the world were such that no post-war capitalist country could survive unless it became a “Welfare State”’ ... [W]hat was everywhere impossible was a return to the mass unemployment and to the low level of living of the pre-war years.’
We are faced with a contradiction. On the one hand, reform is vital for tempering the anger and revolutionary impluses of the exploited and impoverished. Keeping the cottage happy, if you will. At the same time, reform is just that: under capitalism, any and all tinkering that disrupts profit is unlikely to cut muster, meaning that the selfsame conditions under which revolutionary consciousness may have developed remain intact. What’s more, as the past eight years of Tory austerity remind us all too painfully, the state can also simply remove hard-fought gains.
For the great Marxist historian E.P. Thompson, this dangerous tension is built into capitalism:
We must, at every point, see both – the surge forward and the containment, the public sector and its subordination to the private ... the welfare services and their poor-relation status. The countervailing powers are there, and the equilibrium (which is an equilibrium within capitalism) is precarious. It could be tipped back towards authoritarianism. But it could also be heaved forward, by popular pressures of great intensity, to the point where the powers of democracy cease to be countervailing and become the active dynamic of society in their own right. This is revolution.
The NHS is the shining success story of parliamentary socialism. Yet both its origin story and its subsequent erosion - an erosion in an especially vicious, precise, and spiteful phase at present - describe precisely the need for extra-parliamentary, revolutionary socialist activity.
The People's Assembly against Austerity are staging a national demo for the NHS on the 30th of June. Information about it can be found here.