Labour’s Foundation of the NHS and the Welfare State

Every now and then the Tories try to claim that Labour did not found the welfare state. They either claim that they did, or they try to minimize Labour’s role in its foundation by concentrating instead on the fact that it was based on the proposals made by Lord Beveridge in his report of 1943. But the NHS was effectively founded by Nye Bevan, who became the minister responsible for its establishment under Clement Attlee. Furthermore, the ultimate origins of the welfare state and NHS lay with the Webb’s minority report on the state of healthcare in Britain in 1906. The Socialist Medical Association demanded a socialized system of healthcare in the 1930s, and this was taken up by the Labour party. The Fabian Society in this period also produced a series of reports arguing for the establishment of what would be known as the NHS. Francis Williams, in his biography of Ernest Bevin, another minister in that great Labour government, also describes this process. He writes of the Labour party in the 1930’s

To most of its opponents at this time the Labour party seemed to be wasting its time on producing a whole series of policy reports which stirred little public interest and which seemed unlikely to have any practical administrative significance. In fact, however, these policy reports which, beginning with ‘Currency, Banking and Finance’, went on to ‘The Land and the National Planning of Agriculture’, ‘The Reorganisation of the Electricity Supply Industry” and ‘National Planning of Transport’ (all completed within two years of the 1931 defeat) and, continuing therefore, year after year, on almost every aspect of national policy including coal, iron and steel, a National Health Service, Education, Pensions, Unemployment, Industrial Insurance, Housing and Colonial Development, provided the party with the practical programme on which it eventually secured a parliamentary majority and laid for the foundations for the packed legislative programme of 1945 to 1950. (Williams, Ernest Bevin (London: Hutchinson 1952), pp. 182-3).

Now the NHS and the welfare state is being threatened by the Tories, the Lib Dems, and the Blairites. The present Labour leader, Jeremy Corbyn, has pledged to restore the welfare state, renationalize the NHS, as well as part of the electricity grid, water and the railways. This is all very much needed, and it’s very far from being some kind of Communist programme, as the hysterical press and BBC would like us all to believe. It’s simply a partial return to the programme of the 1945 Labour government, which gave the country over three decades of prosperity and economic growth before the election of Thatcher.

Thatcher’s policies of privatization, the decimation of the welfare state and the privatization of the NHS has resulted in mass poverty. It has increasingly been shown to be threadbare. If Britain’s working people are to be given proper jobs, proper rights at work, continuing free healthcare and a genuinely fair provision for their old age, sickness and disability, we have to go back to the old Labour programme of the ’30s and ’40s, and get May and her profiteers and murderers out, and Corbyn in.

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!

Sidney and Beatrice Webb’s The State and the Doctor Available as Internet Download

I’ve been blogging recently about the roots of the NHS in the Beveridge Report of 1942, and, going further back, the campaigns of the Socialist Medical Association and the Fabians, Sidney and Beatrice Webb. The Webbs’ book, The State and the Doctor, is available from Amazon. It’s also available as a free download from the Internet Archive. The book critically surveys the then-current state of medical care, and its often deplorable defects. The two final chapters, ‘The Need for a Unified Medical Service’ and ‘Cutting through the Tangle’ present the case for something very like the modern NHS. They examine the alternatives, and state that insurance based medical provision is inadequate. Which should be obvious, but unfortunately isn’t after nearly forty years of Thatcherite hype. If you want to read it, it’s at:

https://archive.org/details/statedoctor00webbrich

The Immense Popularity of the Beveridge Report, and its Reception by Labour and the Tories

A week or so ago I had a debate on here with a critic, who objected to my crediting Aneurin Bevan with the creation of the NHS. He asserted that the Beveridge Report, on which the NHS is based, was a policy of the wartime National Government, and also had Conservative support.

This is true. However, the Beveridge Report was based on the work of Sidney and Beatrice Webb and the Socialist Medical Association, who had been demanding a free medical service for decades. Indeed, a free health service had been Labour party policy since the 1930s. And while the Tories in the Coalition government also supported Beveridge’s outline of the welfare state, it had particularly strong support in the Labour party.

Pauline Gregg in her book, The Welfare State, describes the massive popularity the Beveridge Report enjoyed with just about all parts of the British population on pages 19-20.

On November 20, 1942, only seventeen months after the appointment of the Committee, it was ready and signed. On December 2, it was made available to the public, and seen at once to go even beyond the expectations of The Times. Though called, simply, Social Insurance and Allied Services, it was an eloquent cry to end poverty, disease, and unemployment, and purported to supply the means of doing so. Its appeal was instantaneous. Queues besieged the Stationary Office in Kingsway. Not only the Press but BBC news bulletins summarized the Report. Brendan Bracken, the Minister of Information, needed only a few hours in which to perceive its enormous propaganda value, and soon it was being trumpeted across the world in many languages. At the cost of 2s, the then normal price of a government White Paper, it immediately became a best-seller at home and abroad, the subject of leading articles, letters to the Press, speeches and discussions at every level of society. Beveridge himself explained his Plan to millions on the radio and on the cinema screen, as well as addressing countless meetings. In twelve months 256,000 copies of the full Report were sold, 369,000 copies of an abridged edition, 40,000 copies of an American edition. Permission was given for translation into Spanish, Portuguese, and German. Translations were published in Argentina, Brazil, Portugal, Mexico, and Switzerland. Parts 1 and VI were translated into Czech, the abridgement into Italian and Chinese.

The Trades Union Congress and the Co-operative Party gave it their blessing. the National Council of Labour, representing all the bodies of organized Labour, called for the legislation necessary to implement the Report at an early date. The Liberal Party supported it, and through Geoffrey Mander welcomed the general principles of “that momentous report”. A group of young Tories tabled a motion in the House of Commons requiring the Government “to set up forthwith the proposed Ministry of Social Security for the purpose of giving effect to the principles of the Report”. “We believe”, said Quintin Hogg, who sponsored this motion, “the keynote of the restatement of political controversy after the war to be practical idealism.” The Beveridge scheme, said another Tory Member of Parliament, “touches the individual life of every man, woman and child in the country and reaches deep down into the homes of the people”. The Labour Party made the Report peculiarly its own. “It expresses”, said Sydney Silverman at its Conference in 1943, “the basic principle of this Party, the only thing which entitled us at the beginning and entitles us now to regard ourselves as fundamentally different from all other parties.” The Report, wrote The Times, had changed the phrase “freedom from want” from a vague though deeply felt aspiration into a plainly realizable project of national endeavour. “Sir William Beveridge and his colleagues have put the nation deeply in their debt, not mere for a confident assurance that the poor need not always be with us, but far a masterly exposition of the ways and means whereby the fact and the fear of involuntary poverty can be speedily abolished altogether.” The Report, it concluded, “is a momentous document which should and must exercise a profound and immediate influence on the direction of social changes in Britain.

Gregg notes on page 23 that in the House of Commons, when it came to a vote only a minority voted for the immediate implementation of the policy. In the end the Labour Party tabled an amendment calling for the early implementation of Beveridge’s plan as a test of Parliament’s sincerity. She also notes on page 25 that many Tory MPs voted against the motion as a reaction against the Plan’s support by Labour.

Meanwhile the Labour amendment was put to the House of Commons. “The Beveridge Plan”, said James Griffiths, moving it, “has become in the minds of the people and the nation both a symbol and a test. It has become, first of all symbol of the kind of Britain we are determined to build when the victory is won, a Britain in which the mass of the people shall ensured security from preventable want. Almost … every comment that has been made in the Press and on the platform since the Report was issued, the widespread interest taken in it and in its proposals, and the almost universal support given to it, are clear indications that the Report and the plan meet a deep-felt need in the minds and hearts of our people.”

But the effect of calling upon a Labour amendment was to unite the Tories against it, in spite of their own speeches, and Griffiths’ amendment was lost by 335 votes to 119, leaving the original non-committal motion to stand. It was a regrettable position. After the welcome and the publicity given to Beveridge’s proposals, and the high hopes raised, the Report was accepted by then sent to another Committee at Whitehall, who spent nearly two years considering it. Further consideration of details had, indeed, been assumed by its author. But the impression given was of shelving the Report, of wriggling out of the proposals. “This”, said Griffiths after the counting of the votes in the House of Commons,” makes the return of the Labour Party to power at the next election an absolute certainty.”

(My emphasis).

The commenter also found my story, about how the pharmacist father of one of my mother’s friends declared he was going to vote Labour because so many people needed the NHS ‘absurd’. This was presumably because he couldn’t accept the idea of a true-blue Tory businessman ever voting Labour. But this paragraph shows this was pretty much what did happen, and the government knew it the moment the Tories voted against the Labour motion.

As for Sydney Silverman’s statement that support for the welfare state is what makes the Labour party fundamentally different from all other parties, it’s a pity that this wasn’t taken on board by Tony Blair and Gordon Brown when they decided to continue Thatcher’s programme of dismantling the welfare state and privatising the NHS. And it’s a pit that it isn’t recognised by Bliar’s successors – Liz Kendall and now Dan Jarvis.

Lansbury, Snowden, the Webbs and the Origin of the Welfare State

A few weeks ago I had a debate on here with a commenter, who took issue with my statement that Nye Bevan set up the NHS. He pointed out that the modern welfare state had its origins in the Beveridge Report of 1942. This is indeed true, but the ultimate origins of the NHS go even further back. Henry Pelling, in his A short History of the Labour Party, points out that when Lloyd George introduced his Insurance Act of 1910, which gave some sickness, unemployment and old age benefits to some workers, his plan to base it on insurance contributions was criticised by George Lansbury, Sidney and Beatrice Webb, and Philip Snowden in the Labour Party. Pelling writes

On the other hand, Snowden and the Webbs, together with Lansbury who had served with Mrs Webb on the Poor Law Commission were united in opposition to this view. Their aim was a National Health Service undertaking preventative measure for the benefit of the whole community. (p. 27).

There is much more to be said about this issue, and about medicine and hospital provision before the establishment of the NHS under Bevan. Nevertheless, the Labour Party was certainly one of the organisations demanding it. The Socialist Medical Association developed the idea of a National Health Service, and it became Labour Party policy in the 1930s.

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.