The doctor’s union, the BMA, often tries to be both trade union and a public health body, and this lack of focus is not good for their credibility in either role. They publish a structured interview column in their weekly journal which, until very recently, used to ask the well known doctor who was the subject of the interview the following question: “Who was the best or worst health secretary – Bevan or Lansley?”
If the NHS is, as described by Nigel Lawson, the closest thing that Britain has to a national religion, then Bevan has become its chief saint. He is referred to fondly as ‘Nye’ by misguided fans on the left as if they knew him personally, and he is still worshipped by them as the arbiter of what a health service should be.
However, it is great Labour Party myth that before Aneurin Bevan in 1948 nothing resembling the health service that we have today existed, because reforms began with the 1906 Liberal government’s initiatives such as free antenatal care and the 1911 National Insurance Act. Of course, this was in an effort to win back votes from the then relatively new Labour Party, but some limited free healthcare was already provided for free by charities, and workers began to insure themselves against illness through voluntary schemes.
The First World War led to the Dawson report about the poor state of the nation’s health that that tragedy had revealed. The Second World War then led to the organisation and nationalisation of hospitals by Geoffrey Rivett into regional networks called the Emergency Medical Service. Further audits such as the Sankey and Gray-Topping commissions led to greater uniformity of the services provided.
The cross-party wartime government recognised that the crisis of the day could be turned into the opportunity of the future, and the Beveridge Report was released to widespread political and public acclaim in 1942. Beveridge, who later became a Liberal Peer, identified five evils in society: squalor, ignorance, want, idleness and disease.
It was the wartime Minister for Health, the Conservative Party’s Sir Henry Willink, who actually published the 1944 white paper in response titled ‘A National Health Service’, which called for the creation of a free universal healthcare system. Medical care at that time was limited in its cost by the available knowledge, with blood groups discovered as late as 1940 and the exact structure of penicillin (then the only antibiotic available) not elucidated until 1945.
Meanwhile Bevan, as a Labour MP, had been busy opposing re-armament in the face of the developments in Europe in the late 1930s. He dismissed the Beveridge report as a “social ambulance scheme”. Given to quoting Marx, many of the social reforms that he himself advocated had already put in place in Marx’s home country of Germany by the conservative chancellor, Bismarck. Churchill broadcast a speech in 1943 titled ‘After the War’ which promised healthcare provision. But after Labour’s post-war election victory, Bevan became Minister for Health and Housing in the new Labour government.
Bevan’s NHS Act was published in 1946, becoming law in 1948, and one of the very few differences with the Conservative 1944 white paper was that GPs became contractors, rather than employees as Willink had envisaged. Almost immediately costs began to grow, and prescription charges were introduced between 1949 and 1951. While this issue of prescription charges (which today are £8.05p for comparison) caused Bevan to resign on principle, he did not retire to the Buckinghamshire farmhouse that he owned but he continued to be active in foreign affairs instead – first opposing and then supporting nuclear weapons.
As doctors, we have moved away from naming illnesses after the men who first described toward more rational scientific nomenclatures, and this should apply to the way that we describe our service provision too: the NHS is not the named property of the Labour Party and they do not have the monopoly on caring. The BMA are perfectly entitled to debate the contributions of various health secretaries, but for them to compare Bevan with Andrew Lansley is sanctimonious and anachronistic. The rigid NHS structures and hierarchies that Bevan presided over are now a barrier to the ambitions and ideals expressed in the 2014 “NHS five year forward view”. While necessity was the mother of the invention of the NHS, Bevan was neither its father nor the midwife – he was at best an obstetrician, arriving when much of the hard work was done and taking most of the glory.