How workers won the NHS
The National Health Service (NHS) is 65 years old on 5 July. Those people who remember life before it are getting fewer.
With non-stop news of overflowing Accident and Emergency departments, hospital scandals and whistle-blowers, is the NHS just another brand going through a tough time? Maybe one whose time has been and gone.
Unison staff at Pinderfields hospital strike, photo Iain Dalton
The Tories and their press deliberately encourage this view. After all, the goods sold by those companies can still be obtained elsewhere – so does it really matter if the NHS disappears in all but name? Wouldn’t treatment still be available from GPs, clinics and hospitals? And so long as they’re free to use does it matter who provides them?
The NHS was created after World War Two, when working class people were determined there would be no return to the poverty, hunger, squalor and diseases of the 1930s.
The history of healthcare and the struggle to win a national health service has vital lessons for today’s health workers, trade unionists and all of us who use the NHS at some time in our lives. Jon Dale writes on the birth of the NHS.
Illness, injury and childbirth meant terror for working class families before the NHS. The Workers’ Birth Control Group had the slogan, "It’s four times more dangerous to bear a child than to go down a mine."
The ruling class feared that if it did not concede real improvements, workers would take action and fight for even bigger change, threatening the entire capitalist system.
A similar situation had existed after World War One. There was a strong mood for real change. Workers had had enough of pre-war poverty and the horrors of the trenches.
Russian workers overthrowing their ruling class and starting to create a workers’ state gave an inspiring example.
The Labour Party agreed its socialist Clause 4 in 1918. The election programme of Labour, then still a new workers’ party, called for widespread nationalisation and minimum standards of health, education, leisure and income for all.
Its vote jumped from 400,000 in 1910 to 2.5 million in 1918. Labour’s growth was one reason why Liberal Prime Minister David Lloyd George set up the first Ministry of Health in 1919.
Workers did not wait for government action to give them a better life. Almost seven times more days were lost in strikes in 1919 than in 1918.
Troops and tanks were sent in to break up a huge strike in Glasgow. Tens of thousands of British soldiers and sailors mutinied in Calais and started to establish a trade union.
Liverpool police went on strike. London dockers refused to load a ship, the Jolly George, with weapons destined for imperialist armies sent to crush the gains of the Russian revolution.
Fight for our NHS, photo Senan
Lloyd George promised to build "a land fit for heroes". He meant that workers could depend on his government to deliver reforms and there was no need to follow the revolutionary road of the Russian working class, or Germany and Hungary where revolutionary uprisings also occurred.
In 1920 Lloyd George asked the king’s physician, Lord Dawson, to report on an organised health service.
Dawson proposed a watered-down version of plans already put forward by a group of radical doctors, the State Medical Services Association.
But his plan was soon shelved. In 1921 a new slump sent unemployment soaring to two million. Right-wing union leaders called off solidarity strikes by rail and transport workers against cuts in miners’ pay.
Seeing the weakness of the working class’s leadership, the government decided there was no need to make concessions.
Four months later public spending cuts were announced – on a scale not repeated until today’s Con-Dem coalition.
By 1925 workers were regaining militancy. A new threat of a general strike was made against attempts to cut the pay of a million miners.
A Royal Commission on National Health Insurance recommended extending it to workers’ dependents.
NHS: Big Business wants a US-style private health care system, photo Paul Mattsson
The 1926 general strike was defeated when right-wing union leaders called it off, although it was growing and paralysing the government.
The Royal Commission’s plans were scrapped. Healthcare for many remained dependent on ability to pay for it.
The 1930s were a period of mass unemployment, terrible poverty and humiliation of working class families through the means test.
Socialist ideas gained support and the Labour Party reflected this with a programme calling for widespread nationalisation.
Many middle class people also moved towards left-wing ideas, feeling that capitalism was failing as a system.
This move to the left was given added impetus with fascism seizing power in Germany and war on the revolutionary Spanish workers.
The Socialist Medical Association grew from 200 to 2,000 members. Left-wing doctors within it drew up detailed plans for a socialised health service, both preventative and curative.
In 1934 it moved a motion at Labour Party conference calling for a national health service.
The ruling class felt far from confident that it had the mass support they needed during World War Two.
Calls to defend king and country – the ’British way of life’ – did not inspire workers in factories, mines or the armed forces who had suffered in the depression.
Pre-war health services were completely inadequate for mass casualties from air raids and the forces.
Many middle class people, forced to use municipal former Poor Law hospitals for the first time, were horrified at their primitive state.
Voluntary hospitals provided better medical and nursing care but were bankrupt. Run as charities, they relied on fees from private patients, legacies and fund-raising events but could barely keep going, asking for government bailouts.
Faced with this grim situation, the government formed the Emergency Medical Service. For the first time, aspects of healthcare were planned on a national basis.
The advantages of cooperation between hospitals and doctors instead of competition for business were soon seen. (The disadvantages of competition are being seen now it has been driven into the heart of the NHS by Cameron’s government.)
Marching against NHS cuts and privatisation , photo Paul Mattsson
To show the working class it would not return to 1930s’ mass unemployment and misery – and fearing a revolutionary wave as followed World War One – the government asked William Beveridge to produce plans for social security.
When this civil servant’s report came out in December 1942 60,000 copies were sold overnight, with 600,000 sold in two years.
He wrote: "A health service providing full preventative and curative treatment to every kind of citizen… without an economic barrier at any point… is the ideal plan."
Beveridge’s plans were opposed by some of the ruling class. Even before Beveridge, an editorial in the Times in March 1941 warned of their post-war fears. "In the aftermath of the war there will be a strong and widespread temptation to abandon the sense of a common effort for a common cause, to resume the rivalry between capital and labour for the extraction of a maximum profit from the process of production…
"If such trends were to prevail… our whole society – national as well as international – might well be in sight of disaster."
On Beveridge’s proposals, Prime Minister Winston Churchill claimed they were unaffordable. Sir John Forbes Watson, director of the Confederation of British Employers said (in private): "We did not start this war with Germany in order to improve our social services."
Other ruling class members were more far-sighted. Tory MP Quintin Hogg, later a cabinet minister, warned in the 1943 parliamentary debate on Beveridge’s report: "If you do not give the people social reform, they are going to give you social revolution." Tory Health Minister, Henry Willink, proposed healthcare should be free but the existing hotchpotch of hospital services should be left untouched. Today’s Con-Dem Health and Social Care Act is returning towards his plans.
Labour’s individual membership climbed sharply at the end of the war, with a million members by 1950.
With pressure from trade unions, workers and their families, and the ranks and junior officers of the armed forces, Labour was committed to real change after the war.
"The Labour Party is a Socialist Party and proud of it," said its 1945 election manifesto. "… the best health services should be available free for all. Money must no longer be the passport to the best treatment."
Labour won a huge majority in the 1945 election. Aneurin Bevan, a former Welsh miner, was appointed minister of health.
Bevan’s plan to create a national health service involved nationalisation of 3,000 voluntary and municipal hospitals. There would be free hospital treatment for all.
He proposed general practitioners be paid salaries, new health centres where they would be encouraged to work and controls on new GPs entering wealthier areas to promote services in poorer areas.
Everyone could register with a GP and dentist, receiving free consultations and treatments. Opticians would also give examinations and prescribe glasses without charge.
British Medical Association leaders strongly opposed these plans (although they did not speak for the whole medical profession).
Dr Alfred Cox, a former BMA secretary, described them as a big step to dictatorship under "a medical Fuehrer".
The British Medical Journal warned that it was inconceivable that "private practice as we know it today can survive as much more than a shadow of itself." (Today the BMA’s position is to the left of Labour’s!)
Bevan negotiated with these leaders and made significant concessions. NHS consultants could continue private practice with private beds in NHS hospitals. GPs remained self-employed, contracting to provide services to the NHS.
Hospitals remained under the control of senior managers and senior consultants, with no democratic control from the local community or health workers through their trade unions.
Nevertheless, the modest involvement of local councillors on hospital boards was more than now exists with Foundation Trusts.
The 1945 government’s biggest concession of all was to leave capitalism in place, only nationalising bankrupt industries (like the hospitals).
Drugs and medical supplies remained private business. In fairness to Bevan, there were few effective drugs in 1948.
The NHS spent £39 million on drugs in its first year (that’s £1.13 billion at today’s prices). It now spends about £12 billion a year on drugs.
The pharmaceutical industry is one of the economy’s most profitable sectors, making 80% profits in some cases.
It should be nationalised and integrated into the NHS with compensation only paid on the basis of proven need.
Bevan expected NHS costs would fall once the untreated burden of illness was dealt with. In fact, NHS costs have risen faster than general inflation throughout its history.
New drugs, joint replacements, transplants, radiotherapy, scans and much more have been developed.
Improved living standards and prevention of many infectious diseases have contributed to an ageing population.
Many more people now live with chronic conditions needing long-term treatment and care, leading to rising costs.
Life in unequal capitalist society is still responsible for ill health, including many cancers, much mental illness and rising obesity.
There is now a widening gap between the health of the richest and poorest – and their access to healthcare.
Low pay, benefit cuts and the bedroom tax will force more into overcrowded, poor quality housing. Many can’t afford good food or adequate heating. The infectious diseases and malnutrition of the 1930s are set to return.
Marching against NHS cuts and privatisation – protest by Royal College of Nurses (RCN) in 2006, photo Paul Mattsson
In 1945 the ruling class feared workers’ revolution and conceded the NHS. It was so popular that later Tory governments dared not attack it.
Bosses benefited from a fitter workforce. Unemployment was very low for 25 years after the war so they needed workers back at work after illness or injury. That started to change after the 1979-81 recession, which saw unemployment soar.
The decline of manufacturing industry left big business looking for alternative sources of profit. Public services have been in their eye since then.
But even Thatcher took a cautious line with NHS privatisation, restricting it mostly to cleaning, laundry and catering.
What held her back was fear that Labour and the unions could mobilise the tremendous support for the NHS among the working class and throw out her government.
She needn’t have worried. Tony Blair and Gordon Brown’s New Labour accelerated down the privatisation road.
Health workers and working class families have our arms tied behind our backs without a party opposing all cuts and standing for renationalisation of the NHS.
Union leaders who rejected a national campaign of demonstrations and strikes to defend the NHS gave the Con-Dems confidence. As in 1921 and 1926, union weakness led to government aggression.
At last, unions have organised a national demonstration in defence of the NHS on 29 September outside the Tory party conference in Manchester.
This should be promoted energetically and followed by a 24-hour general strike. Despite all the negative publicity, the NHS still has tremendous support.
A massive strike could be built, splitting the government apart. What was won through struggle in the past will not be given up without a fight.