With Europe laid waste thanks to six years of total war, and a national debt to the tune of 300 per cent of GDP, it wasn’t the ideal time to launch the most ambitious programme of health social security in history.
But the post-war Labour government saw an opportunity to shape the new world into something new; unencumbered by the traditions of the past.
Certainly, this was the thought process of Aneurin “Nye” Bevan, the Labour Minister for Health responsible for the enactment of the National Health Service Acts.
A Welsh miner from a newly converted socialist family, his role in the establishment of the NHS has seen him held as one of the most exalted heroes of the Labour Party and, in 2004, as the greatest ever Welshman. His achievement was ensuring every person in the United Kingdom, regardless of background, had access to medical care free at the point of use. It was the cornerstone of post-war Labour’s vision of social democratic society – a “new Jerusalem” in an impoverished Britain. But much like the original Jerusalem in 1948, not everybody bought in to the new reality.
This opposition was not limited to the Conservative Party, many of whom were in favour of their former National Government reforms, or indeed the Labour Party.
For those who’ve witnessed battles between successive governments and doctors staunchly defending the system, it is worth remembering that one of the biggest hurdles to the establishment of the NHS was the doctors’ trade union; the British Medical Association.
Bevan would later reflect on his difficulties in establishing the NHS, saying he “was blessed by the stupidity of my enemies.”. Chief among these adversaries was the secretary of the BMA, Charles Hill. In a perversion of the current status quo, Hill argued healthcare should be paid for by insurance, not taxation. He wasn’t the only one.
In a bizarre twist of history, letters in the BMA’s journal described Bevan as “a complete and uncontrolled dictator” and a “medical Führer”, and the doctors who had agreed to work in the NHS as “quislings”. One especially irked clinician said a nationalised health service was “the first step, and a big one, towards national socialism”.
Doctors then, as today, were viewed as fine, upstanding members of society. But unlike today, they made significant amounts of money by directly charging patients for their services. In particular, the lower middle classes – many of whom had voted for Labour at the previous election for the first time – paid small fortunes to doctors. There was understandable anxiety among the profession that their business model, and the comfortable lifestyles it enabled, would be under threat from being forced into the employ of the public sector.
So how did Bevan deal with this opposition from the very people we would have expected him to be able to count on for support? Well, Mr Hunt, pay attention. First, Bevan recognised he couldn’t run his new, ‘utopian’ vision without the support of the staff that were to make it up. Without doctors, consultants, nurses and surgeons there could be no NHS. Bevan recognised the 1944 White Paper ‘A National Health Service’ had been supported across the House, and, according to the results of a questionnaire issued by the BMA, the majority of doctors.
Thus, it wasn’t the principle of nationalised healthcare which was objected to, but the implementation.
And so, Bevan, in his own words, “stuffed the consultants’ mouths with gold”. He also allowed for a compromise with GPs to avoid them becoming just salaried employees, allowing them to retain an element of their pre-Act income. Ensuring doctors would be no worse off under the proposals removed in a single stroke the major objection many had to the proposals, and robbed the BMA of its main weapon; the ire of its members.
As any politician knows though, it was not sufficient to use just the carrot. In a typically firebrand speech in the Commons on 9 February, Bevan used the stick to savage the BMA itself. He accused the union of being a “politically poisoned” body that had “consistently misled” its members. In all, the speech took half an hour, with the BMA repeatedly attacked. It received significant coverage, and, with support for the National Health Service high among the public, was hugely damaging for the BMA’s public perception.
Overall, the dispute between Bevan and the BMA was largely one sided. Bevan represented a Labour government having just secured a crushing electoral victory, promising a new dawn following the most destructive event in modern British history, and with the overwhelming support of the people and other parties. He was a man with an unswerving commitment to the policy, (as later evidenced by his 1951 resignation over the introduction of prescription charges) and the determination to carry it through at all costs, the BMA never stood a chance.
So, what can Britain’s longest serving Health Secretary, or his successors, learn from this dispute? After all, although Hunt did win his battle, we have seen recently how disruptive the BMA can be in the face of health service reform. Perhaps it is as simple as becoming a benevolent Orodes to a bow-tie wearing Crassus, hoping more gold makes the problem disappear.
Perhaps, in order to avoid the reputational damage Hunt initially suffered, it requires more careful negotiating, eliciting compromise where necessary to remove support from the base for an extended campaign. The biggest pointer though seems to be ensuring, when it comes to the NHS, reforms have the support not only of the people who work in it, but the people who use it. After all, as Bevan probably didn’t say: “The NHS will last as long as there are folk left with the faith to fight for it”.
Stephen McLoughlin, Account Executive