As the NHS turns 72, it is under threat from the free-market dogma that has been underfunding and privatising it, writes John Westmoreland
The NHS came to life on July 5, 1948.
When we celebrate the birth of the NHS, we are celebrating an ideal. Many would think of the NHS provision of health care free at the point of delivery as a socialist ideal, one that rises above the sordid calculation of profit and loss that blights just about everything else in our lives.
As we ponder Britain’s future at the hands of the Tories, and with a trade deal with the USA in the offing, the NHS has to be not just celebrated, but fenced off from the inhumanity of the market that such a deal might countenance.
The NHS is anathema to the neoliberal, socially regressive, dogma that both the Tory Party and Labour Party under Blair, have embraced.
We need to remember that before the NHS health care was rooted in the Victorian Poor Law system where poverty and human need was evidence of fecklessness, a lack of effort and character in the minds of the workhouse regime.
Although criticism of the antiquated Poor Law thinking had been challenged by health professionals throughout the first half of the twentieth century it was still intact on the eve of World War Two.
To coin a familiar slogan - working class lives didn’t matter. Doctor A.J. Cronin, who worked in the welsh coalfields was shocked at the way miners with crippling lung diseases were abandoned once their capacity to labour had gone. He wrote a powerful novel in 1937, later made into a film, called The Citadel in which he excoriated the lack of care miners received.
Cronin told an interviewer, "I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug ... The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system."
The founding of the NHS was a fresh start and a condemnation of ‘the system’ that Cronin had in his sights.
The deficiencies of ‘the system’ were exposed by the Second World War. The British working classes were the decisive factor in the war effort, on the front and in the munitions factories. As well as fighting against the threat of the Nazis, they had to overcome the deficiencies of British capitalism.
These working class efforts transformed politics, because full employment and trade union organisation massively increased the weight of the working class in political considerations. The Tories understood this as much as Labour. As Anthony Eden remarked at the time: 'the old world is dead; none of us can escape from revolutionary changes, even if we would'.
The founding of the NHS by the post-war Attlee government is the high point of Labour’s achievements. The NHS was part of the new welfare state that included family allowances and subsidised foods, and it was utterly transformative.
Rickets, a condition caused by malnutrition that affected children, was wiped out. Cases of polio and tuberculosis rapidly declined. Infant mortality fell from 36 per 1,000 live births in 1948 to 3.9 per 1,000 in 2016.
This happened by improvements in treatment, but also by the simple fact that it was a universal system of health care free to access, and paid for from taxation.
It was also cheaper than other forms of healthcare provision. Until 1969 NHS spending never exceeded 4.5 per cent of Britain’s GNP, whereas in that year the Netherlands spent 5.9 per cent, the US 6.8 per cent and Canada 7.3 per cent.
Aneurin Bevan, the Labour Minister of Health who delivered the NHS in 1948, is a much-celebrated figure on the British left today. Bevan was a former Welsh miner who had experienced the hazards of heavy work. He had been a constant critic of Churchill during the war and fought to prevent Britain returning to the nightmare of the 1930s throughout. It is fitting that Bevan should take a lot of credit for Labour’s landmark reforms.
But Bevan was part of a Labour government that did not seek to transform the state into an instrument of socialism. Indeed the war-time state had been adapted by the conflict to manage national projects such as the NHS. The Labour Party’s critique of capitalism was far from revolutionary. Rather they sought to make the system more efficient.
Keynesian economic policies led by the state would give capitalism the most efficient infrastructure, a base to increase the profitability of the system as a whole. The nationalisations embraced by Attlee had actually been suggested by a series of reports instigated by the war-time Conservative government. For example, the Bank of England takeover was recommended by the Macmillan Report; coal by the Reid Report; gas by the Hayworth Report; and electricity by the McGowan Report.
These nationalisations were never intended to be socialist. They were run as publically owned corporations. There were to be huge benefits in this for the Labour movement such as the growth of industry-wide trade unionism, but the management structure was capitalist. And government management of the nationalised industries was always based on the logic of what would produce the most profit for ‘the system’ as a whole.
The founding of the NHS fits with this logic in that capitalism needs workers to be as fit and healthy as possible, and off work as little as possible. And while every socialist wants to defend the socialist principle of universal free health care, we have to acknowledge that it is an island of care surrounded by a sea full of capitalist predators. And Bevan felt their bite in those formative years.
The British Medical Association (BMA) was anything but socialist. Doctors came from the same privately funded education as the Tories. They were supported by the Tories and their press, and encouraged to resist Bevan’s ‘socialism’.
Attlee and the Cabinet didn’t want war against the BMA for fear of wrecking the entire project. Bevan had to make concessions. Hospital consultants could retain private beds in NHS hospitals. They could maintain a dual income: from private patients and as NHS doctors, including the social prestige that went with it.
They boasted that Bevan had ‘stuffed their mouths with gold’. But he had also conceded to them the power to shape the service going forward. These concessions turned out to be a forward base for future governments to introduce so-called ‘market reforms’.
To defend the NHS, and similarly education, we have to acknowledge that if private provision is allowed to compete with public provision, there is going to be a fight. And neoliberal politicians of whatever party will always favour the market.
The nightmare vision of a predatory profit-driven system has once more returned to haunt us as the NHS is sold off slice by slice to private companies. Any future trade deal with the USA brings that nightmare closer to reality. Simple operations that are still free here cost thousands of dollars in the USA for people without insurance.
For example, for patients not covered by health insurance, an appendectomy in a US hospital typically costs about $10,000-$35,000 or more, depending on the provider, whether the operation is open or laparoscopic, and whether there are complications.
The ghastly choice of ‘pay or die’ is approaching unless we can see it off.
But we cannot defend the NHS on the back foot. Attack is the best form of defence, and the health trade unions are going to be important. However, we should not isolate defending the NHS from our other struggles.
Throughout the Covid-19 crisis the Tories have been exposed as free market ideologues whose obsessions have given us one disaster after another. All the success stories in the current crisis have come from the self-sacrifice and dedication of our frontline workers to the NHS ideal. They put people before profit and have earned the thanks of the country. Johnson’s bluster can’t conceal the utter failure of the market in providing PPE, ventilators, track and trace technology nor even lockdown.
The spending priorities of this privatising government also have to be challenged in a way that Keir Starmer’s forensic brain has not considered. That we need a massive redistribution of wealth to solve the health crisis – both mental and physical – has never been clearer.
Why do people with too much money get tax breaks and bailouts? Why are we spending £205 billion on Trident missiles?
500,000 children in the UK are in poverty and 100,000 of these are in absolute poverty. This level of want and deprivation is a breeding ground for disease. Defending the NHS means fighting the central obsessions of neoliberal capitalism: austerity and war.
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John is a history teacher and UCU rep. He is an active member of the People's Assembly and writes regularly for Counterfire.