The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not an advantage
Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.
Aneurin Bevan, In Place of Fear, 1952
The creation of the NHS was not a formality – it required determination, hard-headedness and money. It also required Nye Bevan.
On the 5th July 1948, a young girl was admitted to Park Hospital in Manchester, to be treated for a liver condition. Little did she know, she was at the focal point of a political and social revolution. Her name was Sylvia Beckingham and she was the first patient to be treated on the NHS. She would later recall:
“Mr Bevan asked me if I understood the significance of the occasion and told me that it was a milestone in history – the most civilised step any country had ever taken. I had earwigged at adults’ conversations and I knew this was a great change that was coming about and that most people could hardly believe this was happening.’
On his visit there that day Bevan described the birth of the NHS as “the most civilised step any country has ever taken” Indeed, for Bevan, it was the culmination of a life long struggle and vindication of a dream fostered in the deep squalor of the Tredegar slums. His journey started at just 13, when he began work as a miner, and by the age of 19 he was chairman of his miners lodge. As a rising political star, Bevan chaired the ‘Tredegar Medical Aid Society’ committee, which greatly shaped his outlook towards health inequalities.
In the medical aid society, members received health care in return for a financial contribution. During his tenure, membership was expanded to include non-miners, to the point that 95% of the town’s population became eligible to receive support. It was one of the first community health services and Bevan swore to export this model to the world.
He now had his blueprint and later explained: “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.
Yet not everyone wanted to be ‘Tredegarised’ and Bevan had the flight of his life to win the people round. The clamour for a state-run health service had certainly grown during the Second World War, when the volume of casualties had reduced the system towards bankruptcy.
Back then, Britain’s 2,700 hospitals were run by charities and local councils. Only those in employment were entitled to treatment under the national insurance scheme in place.
The Beveridge Report of 1942 had outlined a vision for a national health service in order to slay the five giants: Want, Disease, Ignorance, Squalor and Idleness. The report recommended a new system of social security and the paper had been a huge success. When the Allies finally made it to Berlin, a copy was found in Hitler’s bunker. The Nazi xecutive summary noted that it was ‘superior to the current German social insurance in almost all points.’
Labour’s commitment to a national health service was outlined in their ‘National Service for Health’ policy document of 1943. During the war, Labour had pushed the Tories for a consensual commitment to implement the Beveridge report’s findings. However, Churchill was absorbed in war strategy and ruled out any firm commitment on future planning until it was finished. A White Paper was published, but he spoke of Beveridge in private as ‘a windbag and a dreamer’. Churchill also had grave reservations about the motives of Bevan and Arthur Greenwood, who he believed wanted to subvert the wartime coalition.
When the Beveridge Report was brought before the commons, the majority of Labour MPs voted for its immediate implementation. Although the government, of which Attlee was a key figure, had been against this, he cannily allowed a free vote on it. Labour became associated with the reforms, and the Tories were accused of being against them.
Attlee had been in ‘permanent campaign mode’ through the war, preparing the ground for his stunning election victory, and earning the respect of the country with the Labour contribution to the war government. In 1945 Attlee became wary of the Tory commitment to the reforms and when Churchill asked him to keep the war cabinet in place for a transitional period, Attlee refused, citing the need to progress with change.
Before 1945, the role of Health Minister had been a relatively minor one, but for Nye Bevan it was the opportunity to alter society, and the first step towards socialism. He recognised that health was a key factor in social inequalities and needed to be tackled head on. “A free health service is pure socialism,” he announced, “and as such is opposed to the hedonism of capitalist society.”
His assessment of health reform was underpinned by three key principles: to be free at the point of use, available to everyone with a need and to be funded through general taxation. He later outlined his strategy for health IN PLACE OF FEAR by Aneurin Bevan, 1952
When Bevan had published his Bill on the health service in 1946, one former chairman of the BMA described Bevan’s proposals in dramatic terms:
“I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to National Socialism as practised in Germany. The medical service there was early put under the dictatorship of a “medical fuhrer” The Bill will establish the minister for health in that capacity.”
Coming just months after the defeat of Hitler, the comparison to the Nazi’s could have been damaging. The comparison of Labour to the Nazi’s had been rejected at the ballot box a year earlier, when Churchill had compared the party to ‘some form of gestapo’.
Between 1946, and 1948, the British Medical Association (BMA) campaigned vigorously, against the terms Bevan had offered the doctors. The right-wing national press was also opposed to the idea of an NHS. The popular right wing tabloid The Daily Sketch claimed: “The State medical service is part of the Socialist plot to convert Great Britain into a National Socialist economy. The doctors’ stand is the first effective revolt of the professional classes against Socialist tyranny.”
The Tories voted against it 21 times and in one survey of doctors carried out in 1948, the BMA claimed that only 4,734 doctors out of the 45,148 polled, were in favour of an NHS.
Churchill was ferocious in his attack on Bevan. He told him, that unless Bevan “changes his policy and methods and moves without the slightest delay, he will be as great a curse to his country in time of peace as he was a squalid nuisance in time of war.” The Tory amendment stated that it “declines to give a Third Reading to a Bill which discourages voluntary effort and association; mutilates the structure of local government; dangerously increases ministerial power and patronage; appropriates trust funds and benefactions in contempt of the wishes of donors and subscribers; and undermines the freedom and independence of the medical profession to the detriment of the nation.
The Conservative commitment to the NHS has often been disputed by historians. In their 1945 manifesto they claimed:
“The health services of the country will be made available to all citizens. Everyone will contribute to the cost, and no one will be denied the attention, the treatment or the appliances he requires because he cannot afford them.”
Notably, there was no commitment to make the new health service free at the point of use, and given their opposition to Bevan’s proposal and comparisons to the Nazi party, we can assume it would not have been as radical.
There was opposition within the Labour party too. Herbert Morrison felt that local councils were the bodies best equipped to run a health service, arguing that London had the best service in the country.
However, on 26th July, 1946, the Third Reading of the Bill was carried by 261 votes to 113. The world was now watching Britain. The Chicago Tribune led with the headline ‘Pass National Health Service Bill in Britain – Doctors Fight Act That Covers All’. They went on to write ‘the Conservatives opposed the bill… seen as giving too much power to the Health Minister’
The doctors still disliked the idea of becoming employees of the state, and would look to wield their power to prevent it coming to fruition. Doctors were in an extremely powerful position and the government would be forced to compromise. Once the Health Bill came before parliament in 1946, the BMA refused to negotiate.
Bevan took the battle to the streets. Conscious of the public appetite for change, he sought cabinet approval for a mass publicity campaign consisting of guide booklets, posters and information films. When asked whether the negotiations would derail the implementation day, Bevan responded angrily “Why should the people wait any longer?”
He put more pressure on the BMA through a Parliamentary vote on “that the conditions under which all the professions concerned are invited to participate are generous and in full accord with their traditional freedom and dignity”. Bevan opened the debate with an attack on the BMA as a, “small body of politically poisoned people” who had decided “to fight the Health Act itself and to stir up as much emotion as they can in the profession.” He added “they have consistently misled the great profession to which they are supposed to belong”.
Bevan resorted to “stuffing their mouths with gold.” – by allowing consultants to work inside the NHS, whilst remaining able to treat their lucrative private patients. Most doctors earned little from their hospital work and depended on the private patients to boost their income. Bevan would later claimed to be “blessed by the stupidity of my enemies”.
Faced with the threat of strike action, he conceded that GPs would retain the freedom to run their practices and the consultants were given a pay rise, and allowed to keep their private practices. Bevan also pushed up Nurse wages in order to attract new recruits to the cause.
By July 1948, Aneurin Bevan had guided the National Health Service Act through Parliament. The Government resolution was carried by 337 votes to 178. Bevan had won the backing of the PM, who supported the creation of 14 regional health authorities to oversee the service. Bevan told the house ‘the Tories have been manoeuvred into voting against the most exciting and popular of the government’s measures…”.
The Act stated that “it shall be the duty of the Minister to provide throughout England and Wales…” services of hospital accommodation, medical and nursing services, and specialist medical treatment obtained either in hospital or the community”.
On July 5 1948 the National Health Service took control of 480,000 hospital beds, 125,000 nurses and 5,000 consultants. When Nye Bevan arrived in Manchester to receive the keys from Lancashire County Council, the nurses formed a ‘guard of honour’ to greet him.
In the aftermath of the devastating world war, the UK showed the world that a universal health care system was possible. In pursuit of socialism, Labour had stumbled upon their crown jewel with the NHS: universal in nature, brought together through the collectivism and social solidarity of the people.
The iconic Davyhulme hospital where Bevan launched the NHS in 1948 lost its A&E unit in 2013, under the Tory reorganisation. What we wouldn’t give for some of that Bevanite boldness today.