The NHS: an historic gain for the working class

The creation of the NHS and the welfare state was an historic gain for the working class, bringing at least some protection from the red-in-tooth-and-claw capitalism of the 19th and early 20th centuries.

The NHS was the direct result of the Beveridge Report written by the Liberal economist Sir William Beveridge in 1942. This reimagined the role of the state in a postwar nation, setting out to combat the five “great evils” of society: want, disease, ignorance, squalor and idleness.

“A revolutionary moment in the world’s history is a time for revolutions, not for patching,” wrote Beveridge. To a country ravaged by war – a “bankrupt nation”, in Winston Churchill’s words – it was a bold vision of a better future. For the first time there would be a comprehensive health service provided free at the point of need. complemented by the welfare state.

However, long before Beveridge, self-help societies had inspired the fight for state welfare, built on working-class values of collectivism and universalism. As a result, these same values were embedded within the Beveridge Report, becoming explicitly evident by the time the Welfare State was created after 1945.

The Tredegar Workmen’s Medical Aid Society, where the writer and doctor AJ Cronin had worked and where Aneurin Bevan’s father had been treated for miner’s lung, had been formed in 1890 by a merger of local benevolent societies. It was intended to provide medical benefits and funeral expenses to miners, steelworkers and their families – and later the whole community. Members made weekly financial contributions, which collectively enabled them to employ doctors, a surgeon, and to maintain a hospital.

This would become Bevan’s model as he worked on the National Health Service project. As he would explain to the country in 1948: “All I am doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more. We are going to Tredegarise you.”

This dramatisation of the work of a GP, made two years before the NHS was created, reflects some of the attitudes towards approaching change in healthcare.

Cover of the New Kingdom Library edition of The Citadel. Depicts the title and then below an illustration of a doctor with dirt-smeared face in front of a miner who is covered in coal dust. A set of miner's cottages is in the background.

The cover of A J Cronin’s book The Citadel, which contrasted private Harley Street medical practices with the socialised system in the mining town of Tredegar.

Before the welfare state

In 1945, shortly after the war ended, Clement Attlee led the Labour Party to a shock landslide victory over Churchill’s Conservatives, and set about transforming Beveridge’s vision of a welfare state into reality. A major component of this was the creation of a universal health service, available to all and for free. Aneurin Bevan, a prominent left winger and the son of a miner, was tasked with spearheading its creation.

Up until this point, healthcare had consisted of an uneven patchwork of services that varied widely by region.

‘Voluntary’ hospitals, aimed at the ‘sick poor’, provided the bulk of emergency care and relied largely on charity. They were staffed by physicians and surgeons who donated their time and expertise while making a living from their private practice. Municipal hospitals, a vestige of the old workhouse hospitals created under the Poor Laws, were run by local authorities.

Bevan and the NHS

At its creation Bevan famously warned that “The NHS will last as long as there are folk left with the faith to fight for it”.  But as early as 1951 he had resigned over the introduction of dental and spectacle charges.

In 1952 he produced a collection of essays “In Place of Fear”.  His warnings remain as relevant today.

Ironically those opposed to the NHS have taken Bevan’s advice.

“No political party would survive that tried to destroy it”

“No government that attempts to destroy the Health Service can hope to command the support of the British people”.

“They knew the Service was already popular with the people. If the Service could be killed they wouldn’t mind, but they would wish it done more stealthily and in such a fashion that they would not appear to have the responsibility”.

Perhaps the first organized ideas to get rid of the NHS came from Arthur Seldon , one of Thatcher’s heros, in his 1968 book “After the NHS” published by his creation , the Institute of Economic Affairs.  The plot evolved further in Thatcher’s time and has been carried forward by the Neo-Liberal policies of all British Governments since. For the Tories, the Brexiteers and other neo-Liberals, health is a multi-trillion dollar business for exploitation, not a service.

Bevan remains the most significant figure in the history of the NHS. He is still invoked in political discourse, especially in Wales – see What Bevan would think of Blair.

Aneurin Bevan and the Socialist Ideal – Professor Vernon Bogdanor

The text of speeches and memoranda reproduced here where not otherwise indicated is from Charles Webster’s collection “Aneurin Bevan on the National Health Service” published by the Wellcome Unit for the History of Medicine, Oxford 1991.

Aneurin Bevan: An appreciation of his services to the health of the people. Pamphlet published by the Socialist Medical Association about 1960

Aneurin Bevan – Labour’s lost leader BBC site with recordings

Website of the Aneurin Bevan Society

Bevan and the NHS

A dramatic presentation of Nye Bevan and the Fight for the NHS

Brief biography of Bevan

Portraits of Bevan in the National Portrait Gallery

Jennie Lee’s papers in the archive of the Open University

The Miner’s Canary – Let it Fly

 

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