More Tory Lies as Jeremy Hunt Claims the Tories Set Up the NHS

The Tories really can’t stop lying, can they? Now that the British public’s becoming very disenchanted with neoliberalism, and the Thatcherite ideological legacy is up against the wall, waiting for Corbyn to shout ‘Fire!’, they’re doing their best to steal the credit for Labour policies. On Tuesday Mike reported that, while Nye Bevan did indeed set up the NHS in 1948, it was ultimately created by the Tory MP, Henry Willink, who authored a government White Paper about it in 1944.

Willink did indeed author a White Paper laying out plans for something like the modern NHS. However, Mike’s article quotes the Independent’s report on the matter. This in turn cites the comments of Jonathan Ashworth, Labour’s Shadow Health Minister, who states very firmly that the Tories voted against it 22 times. The Indie wrote

“Shadow Health Secretary Jonathan Ashworth said: “Jeremy Hunt’s claim the Tories created the NHS is laughable. The Tories fought it tooth and nail all the way through Parliament on a three-line whip. In fact they voted against the creation of the NHS 22 times including at the third reading.

“Over the last 70 years, the Tories have under-funded and tried to sell off the NHS. Labour governments have always stepped in to fully fund and rebuild the NHS. And so it will again fall to the next Labour government to give the NHS the funding it needs and rebuild it to deliver the quality world class health service every patient deserves.”

Liberal Democrat MP Christine Jardine added to was “astonishing” that Mr Hunt has the gall to claim a Conservative minister was responsible for setting up the NHS, then in the next breath says the health service should be above party politics.”

Quite. In fact, the NHS and the welfare state is based on the Beveridge Report, written in 1944. Beveridge was a Liberal. However, the Socialist Medical Association had been campaigning for a state-owned health service since in the 1930s. And the ultimate origins of the NHS can be found in the minority report published by Sidney and Beatrice Webb way back at the beginning of the 20th century in their comments about the state of medical care in Britain.

A little while ago I had someone turning up on this blog to try to argue that the Tories had also been involved in the creation of the NHS, and weren’t its enemies. As I’ve said, Willink was involved. But Labour was the strongest champion of the Health Service, while the Conservatives lost support in the 1940s by postponing its implementation, citing concerns about cost. Then, five years after the NHS was set up, the Tory right revolted and demanded its privatization, on the grounds we couldn’t afford it.

And coming from Jez himself, this is just more hypocrisy. Thatcher wanted to privatize the Health Service, and was prevented from doing so because there was a massive cabinet revolt. Indeed, it was described as the closest thing to a riot. Her personal private secretary, Patrick Jenkin, made her very aware that the American, private healthcare system, was rubbish. So she modified her policy to simply recommending that 25 per cent of all Brits should have private medical coverage.

Then there was the introduction of the Private Finance Initiative by John Major and Peter ‘I’ve Got a Little List’ Lilley, under which private healthcare companies were and are being given license to build and run hospitals and provide other medical services. Why? Not because of efficiency. The system is spectacularly inefficient, and leads to smaller, fewer, and more expensive hospitals than under the normal system of state funding and management. But Lilley and his Tory colleagues were upset that there was this highly lucrative state sector that their pals in private industry couldn’t get their mitts on. They wanted to open the NHS up to private investment. Providing better healthcare didn’t come into it.

And New Labour continued the privatization of the Health Service. This shouldn’t be surprising, as Blair was Thatcher’s protégé across the Green Benches. She stated that he was her greatest achievement, and was the first person to visit him in 10 Downing Street after he moved in.

And then, in 2012, came Andrew Lansley’s Healthcare Bill, which effectively absolves the Health Minister of his statutory duty to provide effective medical care to everyone. It’s heavily disguised in tortuous, convoluted prose, but this is what it does.

And Jez himself is a massive hypocrite in all of this. As Mike has blogged over and again, Hunt has said in his own book that he wants the NHS privatized. But in order to lull the British public into a false sense of security, he’s trying to tell us how much the Tories ‘treasure’ it. And that they set it up.

He’s saying all this because Labour is going to renationalize the NHS, end PFI and move it all in-house. And that scares him and his big business paymasters absolutely witless. But we desperately need this to happen. We really cannot afford for Britain to succumb to the Tories and their free market hogwash, and become like America, where millions cannot afford medical insurance, and where thousands wait in their cars overnight to get access to free healthcare, when it’s offered.

Save the NHS.

Get the Tories out!

The War and Socialist Demands for a National Health Service before the Beveridge Report

This is following a debate I’ve recently had with a critic, who stated that the National Health Service had its origins in the Beveridge Report of 1942, and was endorsed by Winston Churchill and the Conservatives. This is true, up to a point, though Churchill was initially very cautious about the foundation of a National Health Service. After the War he made a radio speech denouncing the Labour party’s plans for a complete reconstruction of Britain as ‘a Gestapo for England’. However, Michael Sullivan in his book, The Development of the British Welfare State (Hemel Hempstead: Prentice Hall/Harvester Wheatsheaf 1996) also points out that before the publication of the Beveridge, there had been a long process of negotiation and demand for some kind of comprehensive, free healthcare for working people, and that this had become official Labour party policy in the 1934. He writes

Discussions about the reform of British health care had, in fact, occurred between the National Government and interested parties during the 1930s (Abel-Smith, 1984, pp. 424-7). The starting point for these discussions was the extension of health insurance rather than the position adopted by the Socialist Medical Association in the early 1930s. These latter proposals, which became Labour party policy in 1934, included the provision of free services to patients, the establishment of a corps of full-time salaried doctors and the introduction of local health centres which would be the hubs of the health care system. The discussions between doctors and government had emphasised the need to cater for the British Medical Association’s preference for the retention of a large private sector in health and the extension of health insurance to cover hitherto uninsured groups. (Leathard, 1991, p. 24).

During the early war years the departmental civil service encouraged the continuation of these discussions and received deputations from the medical profession and the Trades Union Congress. Events, however, overtook these discussions. The formation of the Emergency Hospital Service had, as we have noted earlier, the effect of providing a planned health service, albeit in the conditions of war.

By 1941, civil servants in the ministry of health, perhaps influenced by the running of the EHS, suggested a comprehensive national health system in which general practitioners would be grouped in health centres associated with local hospitals. In October of the same year, the Minister of Health, the Liberal, Ernest Brown, announced that some sort of comprehensive service would be introduced after the war. The organisational and funding arrangements of the service remained unclear, though the minister did suggest that patients ‘would be called on to make a reasonable payment towards cost, whether through contributory schemes or otherwise (Hansard, 10 October 1941). At this time, a survey of hospital provision was also set under way.

At the same time, professional interests were attempting to influence the shape of any future national health system. First, the voluntary hospitals, which had been in financial difficulties before the war, started to plan to avoid the return of financial ill-health after the war. Their suggested framework for a national health system included a closer co-operation between the two existing hospital systems in which local authority hospitals might buy service from the voluntary sector, a call echoed of course in the 1980s, if in a slightly different form and from a different source!

The British Medical Association and the Royall Colleges were also active. Charles Hill, better Known to a generation earlier than that of the author’s as ‘the radio doctor’, and later to become a Conservative Minister of Health, argued that those who planned first would be more likely to influence the final form [of the health service].’ That planning initially included an acceptance of the ideas emerging about General Practitioner (GP) health centres, as well as those of central planning and of a universal and free service. (Pp. 40-1)

He then describes how the BMA later changed its opinion, and became resolutely opposed to the idea of socialised medicine.

Of the contribution of the Conservative Health Minister, Henry Willink, he says

The White Paper, introduced by the then (Conservative) health minister, Henry Willink, conceded very little to the doctors and the voluntary hospitals. Indeed it was, at first sight, almost as radical in intent as the National Health Service came to be seen. Under this plan, a national health service was to be comprehensive and free and financed out of general taxation and local rates. A closer look at the White Paper reveals acknowledgement of some of the doctors’ concerns, however. The planned service would, as far as the ministry was concerned, be free and comprehensive. There would, nonetheless, be no compulsion for doctors or patients to use the planned public service but doctors who opted into the system would be offered the opportunity to become salaried employees of the central or local state. This latter offer, of course, flew in the face of the formal position adopted by the BMA. (p. 41).

He also points out that Willink appears to have retreated from several of his initial positions due to lobbying from the BMA:

In the succeeding months, political lobbying was intense. BMA leaders engaged in secret negotiations with Willink and appeared to have achieved a large degree of success. It seems that the minister colluded with the BMA in dismembering the proposals contained in the White Paper. First the idea of Central Medical Board was dropped to be followed by the demise of plans for a salaried service organised around health centres. Local authorities, it was now decided, would build health centres, but not control them. Instead GPs would rent the buildings, would be remunerated by capitation fee and be entirely free to engage in private practice. (p. 42).

He also argues against the view that the War was ultimately responsible for the creation of the NHS, and that it was the result of an overall consensus in which there was little left for Labour to do but decide the final details. He writes

The war cannot sensibly be regarded as the midwife of the NHS. Some account must also be taken of pressure for change in health policy during the inter-war years.

As we have already seen, the SMA were successful in placing these recommendations for a national health service on the political agenda during the 1930s. These proposals for a free and comprehensive service with a salaried staff formed the basis of Labour party policy as early as 1934. The proposals put forward during this decade by the BMA were, of course, less radical but acknowledged that there were fundamental weaknesses in available medical cover. On two occasions in the 1930s, it published reports which recommended that each citizen should have access to a family doctor and to the services of appropriate specialists. These recommendation, like later proposals from the BMA, fell far short of a national, or nationalised, health service; the financing of the service was seen as best achieved through a system of health insurance. The BMA were even unwilling to accept the recommendations of its own Medical Planning Commission about the scope of a health insurance scheme (Sullivan, 1992). Nonetheless, the BMA during the 1930sa was ready to concede that co-ordination of any post-war service was most satisfactorily located at the national level. (pp. 42-3).

He also notes that even in the 1920s there were calls for some kind of national health service.

There had, of course, been an even earlier call for a national health service. In fact in 1926 the Report of the Royal Commission on National Health Insurance was published. It acknowledged that the insurance system established in 1911 by a reforming Liberal government had become an accepted part of national life. It suggested, however, that ‘… the ultimate solution will lie we think in the direction of divorcing the medical service entirely from the insurance system and recognising it, along with all other public health activities, as a service to be supplied from the general public funds (HMSO, 1926). (p. 43).

Of the supposed consensus produced by the War in favour of an NHS, he says

While it is undoubtedly the case that the experience of war played some part in promoting ideas about changes in the principles and practices of health care (ultimately represented in the 1944 White Paper), it is far from clear that this process represented a new beginning. War may simply have achieved the acceleration of an already established process of policy movement.

Nor should we fall into the trap of seeing the development of war-time health policy as consensual, leaving a Labour government only to decide on the best way to implement agreed policy frameworks. Though many doctors, even in war time, supported the idea of a health system funded from general funds and including a salaried service, there was critical resistance to some of the measures outlined in Willink’s White Paper. that resistance, from the BMA leaderships and, it must be said, from a small majority of doctors responding to the BMA survey, included resistance to the idea of doctors as public servants and, sometimes, to the idea of comprehensive health system itself.

Even among those medical and other interests favouring the establishment of a comprehensives system, there were conflicts about other issues. While the SMA and the Labour Party and Service doctors supported the idea of financing the service from the national Exchequer, most other doctors and certain elements in the Conservative Party favoured a system of health insurance, either publicly or privately administered. While the former grouping favoured control of the health service by central or local government, many doctors opposed government activity that went beyond central planning functions. While the SMA, Service doctors and local medical officers, the Labour Party and some ministers in the Coalition government favoured a salaried service, this found very little support in the wider ranks of the medical profession.

By the end of the war there was agreement of only a limited nature, which masked a wide divergence of opinion amongst interested parties in the health field and in the wider social politics of health. (P. 44).

He concludes

War-time health policy seems, then, to be of less significance than some claim in defining post-war health policy. Though limited agreement on the need for a comprehensive system had emerged, conflict remained over the nature of that system. More than this, inter-war factors seem to be not insignificant in the growth of pressure for a comprehensive health system. War undoubtedly accelerated the acceptance as orthodoxy hitherto contested arguments. Nevertheless, as Aneurin Bevan was to find out, that orthodoxy was still some way short of a national health service.

It’s therefore clear then that sections of the civil service was aware of the defects in existing health provision in the 1920s, and that the Labour Party was demanding something like an NHS from 1934 onwards. The proximate cause of the emergence of the NHS was indeed the emergency health care system set up in the war to treat victims of bombing and evacuees. I concede to my critic the fact that Churchill was, at times, cautiously in favour of an NHS, and that Henry Willink did advocate a free health care system, although his was not ultimately as radical as that set by Bevan.

Nevertheless, ultimately it was Bevan and the Labour party that set up the NHS in 1946. Furthermore, even though there were elements in the Tory party that certainly supported the creation of the NHS and welfare state, there were still many others that opposed it.

Furthermore, the origins of the National Health Service in a fragile war-time and post-war consensus does not, unfortunately, alter the situation today. The Tory party is determined to privatise the NHS by stealth. Jeremy Hunt has said that he wants the NHS broken up and replaced with private health care. Another Tory apparatchik stated that by 2020, if his party had its way, the NHS wouldn’t exist except as a clearing house for health insurance. This was later denied by the Tory spin machine, would claimed that he instead said that the Tories would succeeded in removing unnecessary health regulations and bureaucracy. In the last government, there were 95 Tory and Lib Dem MPs with interests in private health firms, hoping to profit from the NHS’ privatisation.

The only remaining clear champions of the National Health Service as national, free, universal system are the anti-Blairite wing of the Labour party under Jeremy Corbyn.

And that’s my last word on this issue. At least for now.

The Foundation of the NHS: The Conservatives’ Reaction to the Beveridge Report

As I mentioned in my last post, I’ve been discussing the origins of the NHS with a presumably Tory critic, who took issue with my statement that Nye Bevan is the NHS’ founder. Among his other points, he argues that Winston Churchill was in favour of it, and the NHS would have happened regardless of who was in government at the time.

I have argued that Churchill was in fact highly ambivalent about it. Sometimes he was for it, at other times against. G.C. Peden, in his British Economic and Social Policy: Lloyd George to Margaret Thatcher (Oxford: Philip Allan Publishers Limited 1985) has this to say about the public and the government’s response to the report.

The focus for discussion of postwar social planning was the Beveridge Report on Social Insurance and Allied Services (Cmd. 6404). The Report appeared in December 1942, at a time when ultimate victory could be foreseen and when new incentives had to be found to maintain the war effort. Despite this, the Government was cautious, if not openly hostile, to Beveridge’s proposals for universal social insurance, without means test, against interruption of earning due to unemployment, ill health or old age. It was true that the Anglo-American peace aims in the ‘Atlantic Charter’ of 1941 had included a reference to ‘social security’ but Churchill thought that such plans should be substantially left until after the War. As Harris (1977) has shown, the Beveridge Report had been very much Sir William Beveridge’s own handiwork. His committee had been expected to deal with technical questions related to workmen’s compensation for industrial disease or injury, and with anomalies in social insurance, such as the well-known one whereby a man whose earning were interrupted because of unemployment received a higher rate of benefit than if he were sick. Beveridge, however, had gone beyond his terms of reference and had called for an attack on Disease, Ignorance, Squalor and Idleness as well as Want – the five giants on the road of reconstruction, as he called them in Bunyanesque language. In particular, he stated that no satisfactory scheme of social security could be devised unless there were family allowances, comprehensive health and rehabilitation services, and avoidance of mass unemployment. Indeed, the actuarial soundness of Beveridge’s plan depended upon the average rate of unemployment being no higher than the lowest level in the 1930s; that is 10 per cent of interwar insured labour force or 8.5 per cent of the wider body of insured employees in the new scheme (Cmd 6404, pp. 120, 154-65, 185-6). Uncertainty whether unemployment could be controlled, and memories of the political consequences of an actuarially unsound unemployment insurance fund in 1931, no doubt contributed to the Treasury’s critical reception of the Report.

Nevertheless there can be little doubt that the Report was extremely popular with the general public and, following a backbench revolt in parliament, the Government felt compelled to commit itself to Beveridge’s plan, at least in principle. Widespread support for universal social insurance without means test may have been the result of what Titmuss called a ‘war-warmed impulse of people for a more generous society’. On the other hand, the fact that so many people in the armed forces and munitions industries could not but be uncertain about their own post-war employment, in the light of post-1918 experience, must have been a factor. In the interwar years the unemployed had always been a minority of the electorate; in the war those who felt threatened by unemployment may well have been a majority. Moreover, the associated prospect of universal health insurance may well have been attractive to people had been finding the cost of private health insurance a burden.

Key interest groups were also generally in favour of Beveridge’s ideas. The evidence presented to Beveridge’s committee showed that hardly any trade unions opposed extensions of national insurance and even business witnesses generally favoured more intervention by the state in matters relating to national efficiency. The one business group clearly adversely affected by Beveridge’s proposals were the industrial insurance companies which had helped to administer national health insurance since 1912. Beveridge not only recommended their exclusion from this, but he also proposed that national insurance should cover workmen’s compensation and funeral grants, thus taking away business from the companies. These seem, however, no longer to have had the influence they had had in Lloyd George’s time, and the state no longer needed their administrative expertise. Wartime experience had created new attitudes about what the state could achieve. All this does not mean, however, that there was necessarily a consensus in favour of a ‘welfare state’ except in the most general terms. Looking at Beveridge’s five giants in turn, one finds that sometimes proposals were agreed for differing motives, or on an inadequate basis, and that sometimes there were serious disagreements between Conservative and Labour members of the Coalition government.…

For all its reservations on Beveridge’s main proposals, the Government did agree in principle with his assumption that there should be a comprehensive health service available to all, without any conditions of insurance contributions. The trouble was that it proved to be impossible during the war for the details of such a service to be agreed, either between political parties or with the interest groups involved. Certainly war had increased the state’s role. Greatly exaggerated prewar estimates of numbers of casualties in air raids had led to the provision of 80,000 Emergency Hospital Service beds, compared with 78,000 beds in voluntary hospitals and 320,000 in local authority hospitals. Moreover, the Emergency Hospital Service gradually extended its operations from war casualties to treatment of sick people transferred from inner city hospitals and then to other evacuees. In discussions in 1943-45 on a future national health service, however, both Conservative ministers and the British Medical Association showed themselves to be determined to safeguard private practice and the independence of the voluntary hospitals. In particular, there were deep differences between successive Conservative ministers of health, Ernest Brown and Henry Willink, who were responsible for health services in England and Wales, and the Labour Secretary of State for Scotland, Tom Johnson, who was responsible for health services north of the border. For example, Johnson successfully opposed the idea of maintenance charges for patients in hospital. The 1944 White Paper on A National Health Service (Cmd 6502), which was signed by Willink and Johnston, left much undecided and was avowedly only a consultative document. …
(pp 139-40).

The National Health Service Act of 1946, and its implementation on the Appointed Day in 1948, was a considerable achievement of Aneurin Bevan, the Minister of Health. Bevan’s original nation health proposals differed from those of Willink, his Conservative predecessor, chiefly in respect of the degree of the Ministry’s control over hospitals and doctors, and in the emphasis given to group partnerships of doctors in local health centres. Whereas Willink had wished to preserve the independence of voluntary hospitals, Bevan took over all local authority and voluntary hospitals, except those not necessary for the National Health Service (NHS). Bevan’s biggest problem was with the British Medical Association which, as late as February 1948, organised a poll of its members which resulted in a vote of 8:1 against the Act. Bevan was aware of the need to meet the medical profession on some points. In particular, he was willing to allow private beds in NHS hospitals so as to attract the best specialists into the service. He met the general practitioners’ fears for their independence by promising that there would be no wholetime salaried medical service. In the end the doctors and consultants were given a larger place in the administration of the NHS than Willink had envisaged.

(pp. 155-5). Thus, while the Tories did have a role in the creation of the NHS, the government as a whole only reluctantly accepted its necessity after it won a general acceptance amongst the electorate and parliament. Yes, Willink did play his part, but the ultimate creation of the NHS was under Nye Bevan.

There is much, much more I could write on this, but at the moment this ends the discussion.

Nye Bevan and Nostalgia for the Era Before the NHS: My Response to a Critic

Last week I received a comment from Billellson criticising me for stating that Aneurin Bevan was the architect of the NHS. He also stated that we did not have a private healthcare system before the NHS, and although some charges were made, they were in his words, not so much that people would lose their house.

Here’s what he wrote.

“Nye Bevan, the architect of the NHS, was also acutely aware of the way ordinary women suffered under the private health care system that put medicine out of the reach of the poor.”
Aneurin Bevan was not the architect of the National Health Service. The NHS was a wartime coalition policy, for the end of hostilities, agreed across parties. The concept was set out in the Beveridge Report published in December 1942, endorsed by Winston Churchill in a national broadcast in 1943 and practical proposals, including those the things the public value re the NHS today, set out in a white paper by Minister of Health Conservative Henry Willink in March 1944. It would have been established whoever was Minister of Health after the war / whichever party won the 1945 general election. The UK did not have a ‘private health care system’ before the NHS. Most hospitals in England and Wales were local government owned and run, the remainder voluntary (charitable). Those who could afford to pay for treatment were required to do so, or at least make a contribution, but nobody was expected to sell their house. The poor were treated in hospitals free of charge. c11 million workers were covered for GP consultations by the National Health Insurance Scheme which had been established in 1911. In many places, particularly mining areas, there were mutual aid societies that established health facilities including dispensaries. Scotland had a greater degree of state health provision and Northern Ireland had greater faith based provision before their NHSs were established, starting on the same day as Bevan’s English and Welsh service, but always separate established under separate legislation.

So I checked this with what Pauline Gregg says about the creation of the NHS in her The Welfare State: An Economic and Social History of Great Britain from 1945 to the Present Day (London: George G. Harrap & Co 1967).

She states

In 1942, during the War, the scope of health insurance had been considerably widened by the raising of the income limit for participation to £420 a year. But it still covered only about half the population and included neither specialist nor hospital service, neither dental, optical, nor hearing aid. Mental deficiency was isolated from other forms of illness. Medical practitioners were unevenly spread over the country – they had been before the War, but now their war-time service had too often disrupted their practices and left their surgeries to run down or suffer bomb damage.

Hospitals were at all stages of development. There were more than a thousand voluntary hospitals in England and Wales, varying from large general or specialist hospitals with first-class modern equipment and with medical schools attended by distinguished consultants, down to small local cottage hospitals. There were some 2000 more which had been founded by the local authorities or had developed from the sick ward of the old workhouse, ranging again through all types and degrees of excellence. Waiting-lists were long; most hospitals came out of the War under-equipped with staff and resources of all kinds; all needed painting, repairing, reorganising; some were cleaning up after bomb damage; most needed to reorient themselves before they turned from war casualties to peace-time commitments; all needed new equipment and new buildings. Other medical services were only too clearly the result of haphazard development. There were Medical Officers of Health employed by the local authorities, sanitary inspectors concerned with environmental health, medical inspectors of factories, nearly 2000 doctors on call to industry, as well as doctors privately appointed by firms to treat their staff. A school medical service provided for regular inspection of all children in public elementary and secondary schools; local authorities provided maternity and child care, health visiting, tuberculosis treatment, and other services for the poor, which varied widely from district to district. How many people there were of all ages and classes who were needing treatment but not getting it could only be guessed at.

Since it was clear that ad hoc improvement would no longer serve, a complete reshaping of the health and medical service marked the only line of advance. The general pattern it would take was indicated by Sir William Beveridge, who laid down his Report in 1942 the axiom that a health service must be universal, that the needs of the rich and poor are alike and should be met by the same means: ” restoration of a sick person to health is a duty of the state … prior to any other,” a “comprehensive national health service will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires it, domiciliary or institutional, general, specialist or consultant, and will ensure also the provision of dental, ophthalmic and surgical appliances, nursing and midwifery and rehabilitation after accidents.”

The Coalition Government accepted the Health Service Proposals of the Beveridge Report and prepared a White Paper, which it presented to Parliament in February 1944, saying the same thing as Beveridge in different words: “The government .. intend to establish a comprehensive health service for everybody in this country. They want to ensure that in future every man and woman and child can rely on getting all the advice and treatment and care which they may need in matters of personal health; that what they get shall be the best medical and other facilities available; that their getting these shall not depend on whether they can pay for them, or any other factor irrelevant to the real need – the real need being to bring the country’s full resources to bear upon reducing ill-health and promoting good health in all its citizens.” The Health Service, it said, should be a water, as the highways, available to all and all should pay through rates, taxes and social insurance.

Ernest Brown, a Liberal National, Minister of Health in the Coalition Government, was responsible for a first plan for a National Health Service which subordinated the general practitioner to the Medical Officer of Health and the local authorities, It was abandoned amid a professional storm. The scheme of Henry Willink, a later Minister of Health, was modelled on the White Paper, but was set aside with the defeat of Churchill’s Government in the 1945 Election. In the Labour Government the role of Minister of Health fell to Aneurin Bevan, who produced a scheme within a few months of Labour’s victory.

Pp. 39-51.

Churchill’s own attitude to the nascent NHS and the emergence of the later welfare state was ambivalent. In March 1943, for example, he gave a speech endorsing it. Gregg again says

He was “very much attracted to the idea” of a Four Year Plan of his own which included “national compulsory insurance for all classes for all purposes from the cradle to the grave”, a national health service, a policy for full employment in which private and public enterprise both had a part to play, the rebuilding of towns and a housing programme, and a new Education Act. He envisaged “five or six large measures of a practical character”, but did not specify them, … (p. 25).

However, two years later after the Beveridge Report had become the official policy of the Labour party, Churchill’s tone was markedly hostile.

Coming to the microphone on June 4, 1945, he said: “My friends, I must tell you that a Socialist policy is abhorrent to British ideas of freedom … Socialism is in its essence an attack not only upon British enterprise, but upon the right of an ordinary man or woman to breathe freely without having a harsh, clumsy, tyrannical hand clapped across their mouths and nostrils. A free Parliament – look at that – a free Parliament is odious to the Socialist doctrinaire.” The Daily Express followed the next day with banner headlines: “Gestapo in Britain if Socialists Win”. (pp. 32-3)

So Mr Ellson is partly right, but only partly. There was some state and municipal healthcare provision, but it was a patchy and did not cover about half the population. It was a Coalition policy, which was sort of endorse by Churchill. However, its wholehearted embrace and execution was by the Labour party under Aneurin Bevan.

And its immense benefit and desirability was recognised by many traditionally staunch Tories at the time. One of my mother’s friends was herself a pillar of the local Conservative party, and the daughter of a pharmacist. She told my mother that at the 1945 elections her father gather his family together and told them that he had always voted Tory, but this time he was going to vote Labour, because the country needed the NHS. He explained that he served too many people, giving them their drugs on credit, because they couldn’t pay, not to vote for Labour and the NHS.

Now I think the Tories would like to roll state healthcare provision back to that of the pre-NHS level, where there is some minimal state provision, but much is carried out by private industry. The Daily Heil a few years ago was moaning about how the friendly societies were excluded from a role in the NHS. Like them, I think Mr Ellson has far too rosy a view of the situation before the NHS. I’ve blogged on here already accounts from doctors of that period on how badly much of the population were served before the NHS, especially those without health insurance.

Britain needed the NHS, and the party that was most passionately in favour of it was Labour. That some Tories were in favour of it, including Churchill on occasions, is true. But there were others in the party that were very firmly against, and it was ultimately Rab Butler in the Tories who reconciled them to the NHS. But that reconciliation is breaking down, and they are determined to privatise it anyway they can.

D-Day and the Creation of the NHS

Earlier today I reblogged Mike’s article attacking the censorship of one of the posters to the Labour Forum. This person, agewait, had had their posts repeatedly removed from the Forum and been told that they were ‘very offensive’. They had created the image reproduced here at the top of this very post, showing the courageous D-Day servicemen about to do battle, and linked it to Harry Leslie Smith’s attack on the government’s reform of the NHS. The Forum immediately deleted the posts, and responded to agewait’s inquiry why they were doing this with the statement:

“D-Day and the NHS have nothing to do with each other. Whatsoever. Any photos trying to link today’s political issues with D-Day are offensive and will be deleted immediately.”

Agewait himself gave his account of what happened in a comment to Mike’s article:

Thank you for highlighting this issue. I am the creator and apparent antagonist by posting this and another related post on the so called ‘Labour Forum’. I was angered by their actions and told them so (without swearing) – I asked for them to be reinstated, but I was threatened with a ban – So I told the jumped-up, swaggering b*****d just what I thought about him and his tin-pot political correctness, knowing full well I would be banned. I was extremely angry with them for initially removing the posts and angered more by the explanation which was not only inaccurate but extremely patronising. I am not anti-labour, but it does appear to be anti-working class… It is time it realised the people didn’t leave them, they left us…. disengaged chatterers…. and out of touch with the passion people have for the injustices against so many people who have witnessed a blitzkrieg attack upon their NHS and their Social Security system with so many, too many so called labour MPs standing by whilst others cash in on their financial interest in the Private Health sector…. Thanks again – Injustice Anywhere is a Threat to Justice Everywhere. I feel they should apologise for removing the posts – I don’t expect or wish for a personal apology not after sharing a small section of my anger and disgust with their outrageous tactics. Adrian Wait.

The Labour Forum’s censorship is wrong and completely ahistorical. Mike has already pointed out in his article that the Beveridge Report setting up the NHS was in response to concerns about the victories of the German army at the start of the War, which drove us out of France and back to Britain. The Germans were better nourished and healthier, with the support of old age pensions, unemployment and sickness insurance brought in by Bismarck in the 1870s. When the Liberals first introduced these measures shortly before the First World War, the Germans boasted that the Reich had already had them for over forty years.

Richard Titmuss in his 1950 Problems of Social Policy, which linked the creation of the welfare state very firmly to the experience and necessities of providing for the civilian population during the War. G.C. Peden in his British Economic and Social Policy: Lloyd George to Margaret Thatcher, states

Titumuss argued that the hazards of war were universal and that prewar principles of selectivity could no longer be applied. Bomb victims could not be treated like recipients of poor relief. The Unemployment Assistance Board, which became simply the Assistance Board, was used to pay out hardship allowances, rather than leave these to local Public Assistance Committees, which were associated in the public mind with the Poor Law. When inflation reduced the value of old age pensions, the Assistance Board was empowered to pay supplementary pensions based on need, and by 1941 the Board was dealing with ten times as many pensioners as unemployed men. As Minister of Labour, Bevin insisted on abolishing the household means test, and the Determination of Needs Act of 1941 substituted an assumed contribution from non-dependent members of a family. Titmuss stressed cross-party support for welfare policies. According to him (pp. 506-17), the condition of inner city children evacuated to more prosperous areas shocked public opinion and moved the Government to take ‘positive steps’. Cheap or free school meals and milk were made available to all children and not, as hitherto, only to the ‘necessitous’. Free milk, orange juice and cod liver oil were provided for all expectant mothers and for children under five years. In all these ways, Titmuss argued, the ‘war-warmed impulse of people for a more generous society’ created favourable conditions for planning ‘social reconstruction’ after the war. (pp. 135-6).

Titmuss’ view has now been criticised, as Titmuss was excluded studying plans for post-War policy, and so his view did not necessarily correspond to the government’s actual intentions. Peden notes that the outbreak of the War halted slum clearance, house building, and may have delayed the extension of national insurance to workers’ families and dependence and the introduction of family allowances. The Tories own Research Department had been worried about their own chances of winning elections before the War, and so had suggested including the above measures in their manifesto. On the other hand, the TUC had opposed Family Allowances, as they feared this would allow employers to pay low wages, and there was little support for them from the government. (p. 135).

Peden does state that the War brought a massive expansion of state hospital provision, and that the government agreed with the Beveridge Report’s recommendation that there should be a free health service, while acknowledging that the Tories and the British Medical Association also wished to preserve private practice and the charity hospitals:

For all its reservations on Beveridge’s main proposals, the Government did agree in principle with his assumption that there should be a comprehensive health service available to all, without any conditions of insurance contributions. The trouble was that it proved to be impossible during the war for the details of such a service to be agreed, either between political parties or with the interest groups involved. Certainly was had increased the state’s role. Greatly exaggerated prewar estimates of numbers of casualties in air raids had led to the provision of 80,000 Emergency Hospital beds, compared with 78,000 beds in voluntary hospitals and 320,000 in local authority hospitals. Moreover, the Emergency Hospital Service gradually extended its operations from war causaulties to treatment of sick people transferred from inner city hospitals and then to other evacuees. In discussions in 1943-45 on a future national health service, however, both Conservative ministers and the British Medical Association showed themselves to be determined to safeguard private practice and the independence of the voluntary hospitals. In particular, there were deep differences between successive Conservative ministers of health, Ernest Brown and Henry Willink, who were responsible for health service in England and Wales, and the Labour Secretary of State for Scotland, Tom Johnston, who was responsible for health services north of the border. For example, Johnston successfully opposed the idea of maintenance charges for patients in hospital. The 1944 White Paper on A National Health Service (CMd 6502), which was signed by Willink and Johnston, left much undecided and was avowedly only a consultative document.

Peden then goes on to state that there is little evidence that the War created a lasting consensus in favour of the Welfare State. He does, however, agree that the experience of the war created a more universalist approach to social problems, and that it led to the main political parties meeting on a ‘Butskellite’ centre. (pp. 142-3). He considers instead that the solutions recommended by the Wartime government were merely attempts to deal with temporary insecurity caused by the War.

Nevertheless, the War had led to the demand for the creation of the NHS, and the massive expansion in state hospital provision. And the Labour party played on the desire to create a better society for the servicemen and women, who had fought so hard against Fascism and the Nazi menace, as shown in the poster below.

The Tories too, have had absolutely no qualms about using images from WW2 in their election propaganda. I can remember their 1987 election broadcast being awash with images of dog-fighting Spitfires, ending with an excited voice exclaiming ‘It’s great to be great again’. All while Thatcher was doing her level best to destroy real wages and smash Britain as a manufacturing nation in the interests of the financial sector. The satirist Alan Coren drily remarked that the broadcast showed that the War was won by ‘the Royal Conservative Airforce’, and stated that it was highly ironic that in reality all the servicemen went off and voted Labour.

All this seems to have been lost on Labour Forum, which suggests that the mods in charge actually don’t know much about Socialism or the creation of the NHS. You could even wonder if they were actually Labour at all. If they were, then it certainly looks like a Blairite group, afraid that linking D-Day and the origins of the NHS will disrupt its part privatisation introduced by Blair. Many of the firms involved in this were American, and there is certainly massive hostility to any inclusion of the NHS as one of the great achievements of British history by the transatlantic extreme Right. They were fuming, for example, at Danny Boyle’s inclusion of the NHS in the historical tableaux at the opening ceremony of the 2012 Olympics. The censors over at Labour Forum seem to reflect this mentality, rather than anything genuinely and historically Labour. It’s time the Right-wing censors over at Labour Forum were finally shown the door, and a proper historical perspective and pride taken in the NHS, one of the great legacies left by the people, who fought so bravely to keep Europe free.