The article below is one of several contributions to the pamphlet Aneurin Bevan: An Appreciation of his service to the health of the people, published by the Socialist Medical Association about 1960, price one shilling.
Bevan and the N.H.S.
By D. STARK MURRAY,
B.SC., M.B., CH.B. President Socialist Medical Association; late Editor “Medicine, Today and Tomorrow“
This is a purely personal assessment of the relationship between Aneurin Bevan and the National Health Service; two great subjects on which it is doubtful if any two people would agree but from which many lessons for the future have yet to be drawn. To act on these lessons will be to honour Aneurin Bevan in the way he would have best liked.
Medicine and socialism have basic similarities. Both must be free from doctrinaire ideas and both must be flexible and for ever growing and developing; but both must be universal in scope, appeal and result. Disease and death are universal and the system of medicine which fights to prevent them must be applied universally; socialism is based on universal brotherhood and in the ultimate analysis will be realised only in a universally applied system.
In addition, medicine and its practical application through the health service lends itself to the application of socialist principles, above all that the maximum will be done for all at all times without reference to financial, social or racial status.
It will be seen that for a life-long socialist who had early seen the effects of disease and of industrial hazard and who had joined in the South Wales miners’ own efforts to deal with these effects through their local medical schemes, the chance to apply socialist principles was one not to be missed. When Labour swept the polls in the first post-war election in 1945 there were those who thought Aneurin Bevan, in becoming Minister of Health had not aimed as high as he might. But for Bevan this was as high, in terms of applying socialism to the common man, as anyone could aim, and in the event the one great effort in socialism which Labour so firmly established that consequent political changes have failed to move it.
But it was not only a great opportunity to show socialism at work, it was one that called for a man prepared to fight vested interests and to make great political decisions. The vested interests tried to keep up pressure against the N.H.S. and did force some unnecessary and unwise compromises on the Ministry of Health, but no one who heard or read his speech on introducing the main debate on the subject ever doubted that he would fail to gain the support of the whole nation.
If one thinks so, why were there unnecessary compromises? Because, in the words of our title, Aneurin Bevan was human and in his character combined strength and weaknesses as do all men, however great. When he saw that a socialist principle was at stake and he was opposed by men he recognised as anti-socialist, which included most doctors, he knew all the answers and had all the strength needed. This was seen in his decision to have a single hospital system and to amalgamate the municipal and voluntary hospitals under Ministry of Health control. To establish the highest standard of hospital care he saw that we must have one hospital system; yet he left out the Teaching Hospitals in England and Wales and he allowed two kinds of consultants, the part-timer with his main interest, outside the national service, in his private practice which is heavily subsidised by the state, and the whole-timer giving all his time to his hospital work in spite of being penalised financially.
Of course, Bevan can never have imagined, for few did, that Labour would be out of power three years after the start of the N.H.S. and that his successor would not be a socialist with new electoral authority to develop the service fully. He certainly meant what he said about Health Centres, the “pivot of the service” but never overcame the difficulty which the Act created that doctors and local authorities could get together politically to create an atmosphere against Health Centres that only a very strong central edict could have overcome. At one moment he had plans prepared for low price standardised health centres of various sizes, but they were never issued. If only twenty or thirty had been started, even if it meant forcing the pace with some county councils, the story might have been very different. It was this failure, linked to the Cripps unsocialist conception of a “ceiling” on health service spending which later made it easy for Tory governments not to press on with health centres and for the Labour Party to be talking in 1960 of group practice experiments which the Bevan of 1947 would have cast aside with withering contempt.
Although Bevan understood the need for health centres he never clearly understood that they could function as socialised centres only if doctors were paid on the same basis as the rest of the team. He did not accept that a socialist health service could be developed only in the hands of whole-time officers and so he perpetuated the capitation fee system, with lists that were too big. By abolishing the buying and selling of medical practices he opened the way to a rational system of general practice but failed to go to the end of the road. In part this was because he was badly advised as to the cost of the health service and did not realise that he could control the cost of general practice and drugs only by a salaried service.
It looked easier to control the cost of the hospitals, but insufficient allowance was made by the financial experts at the Ministry of Health for the neglect our hospitals had suffered during the war and still less for the way the cost of hospital care would rise when all modern scientific methods were applied to half a million neglected hospital beds. The hospitals needed more money but they also deserved better and more socialist controllers than Bevan put on the Regional Hospital Boards. He was right to say that in a democratic country no Minister could pack such Boards with people of his own political party; but he bent over backwards to resist any accusation that he had put socialists in power on these Boards. The result was that the hospital service did not get off so smartly as it should have done under a socialist minister and it was very easy for the next Conservative Government to remove the few socialists Bevan had put on each Regional Hospital Board.
These may be regarded as small points compared with the great advances that are made, but one is tempted to wonder what would have been the result had Bevan stayed Minister of Health for a longer period than he did. Would he have found a way to introduce the vital type of service we still need in industry; and would he have stimulated medical research as it has not yet been stimulated. Above all would he have seen that we should be educating more doctors in this country than we are doing (and a lot more dentists and dental hygienists) and could he have influenced medical education so that the new doctors would be given a clear conception of the loyalty the service and its patients call for. That conception would be based on a humanitarian spirit which is still not to be found in every part of the service. Aneurin Bevan understood the need for that and it was its absence in some of the negotiations he had to conduct with doctors that made him impatient with the medical profession.
But he made the profession accept and come into the new service and they have never wanted to leave it. Some day they will understand what a socialist like Bevan meant when he talked of a socialist health service and his monument will reach heights even he hardly visualised.