History of England 1-6

Here was a revolution with no clear precedent in England. Whatever G. K. Chesterton may have believed, the monasteries and friaries of pre-Reformation England were not ‘the inns of God where no man paid’. Similarly, those who drew up the Tudor poor laws and established the parish system of relief had no conception of universal healthcare. Victorian refinements to those laws taught the lesson that sickness should be understood as the consequence of feckless living. Even the comparatively enlightened provisions of the 1911 National Insurance Act were confined to working men.

Rationing might have slimmed the nation down, but it had done nothing to avert disease. Tuberculosis, ‘the white plague’ of the Victorians, was still abroad, with few X-rays available to detect it. Diphtheria could cause a child to choke. Rickets and polio crippled the young as surely as they had a century before. Measles could be fatal. Scarlet fever, smallpox and influenza were as widespread as ever. Furthermore, the nation was simply run-down. The faces of the poor showed concave cheeks, chap-fallen jaws, grey, stubby teeth, and a nutcracker profile. As if poor sanitation, overcrowding and unsympathetic elements were not enough, children were still subject to Victorian notions of nutrition, being fed on starchy breast milk substitutes. Indeed, artificial feeding could be as dangerous for children as lack of hygiene. At a time when diarrhoea alone could kill a small child within days, it was common for a hospital administrator to spend half her day filling out death certificates. The imbalance of provision between rich and poor was dark and ugly. There was one GP for 18,000 people in the East End, while in the suburbs ‘it was one for every two hundred and fifty’. Money had to be put on the shelf for the doctor in case anyone fell ill; if there was no money, people would pay in kind, with eggs perhaps, or vegetables.

Medicine was, in every sense, a private affair. Even funding for hospitals was secured by charity parades or private benefactors. The doctor himself was a breed apart. You did not visit him – he came to you. Pre-eminent in that world was the consultant, tailed by his subordinates in the hospital as a king by his courtiers. Any love he or the general practitioner had for the sick might have been considered incidental. Yet the reason for what seems like a rather mercenary approach is simple enough. Before the NHS existed, a GP bought his practice. Like any other professional, he sought to enlarge his business, improve it, and perhaps sell it on at a profit. He had a capital investment in his work and sought to preserve it.

Nye Bevan, for one, did not see why matters should remain so. His own father had ‘died from dust’, in miners’ parlance. Bevan himself had started working in the pits of Tredegar at the age of twelve. He spoke of how food on the plate became a family’s calendar: you knew it was the weekend when there was almost nothing. ‘My heart is full of bitterness,’ he wrote, ‘when I see … the ill and haggard faces of my own people … There must be another way of organising things.’ There was, and it lay nearby. The Tredegar Medical Aid Society had been founded at the end of the previous century as a means of providing the local workers with healthcare they could not otherwise have afforded. Workers put in ‘thruppence a week’ of their earnings and received free medical, dental and optical care. It was, as one resident recalled, a ‘miniNational Health Service’. Bevan took it as his template.

The National Health Service Act had been passed along with the rest of the welfare legislation, but the other bills would not need quite such lavish preparation. The Conservative party under Churchill was opposed to Bevan’s proposals on the basis of cost. Bevan wanted a truly national health service, invested in by the employee but sustained by taxation. But this, its opponents argued, would be costly, unwieldy, ineffective and, given the high levels of taxation required, would necessitate a threat to English liberties. Surely such matters could be devolved to the regions. But the population wanted social change; for what else had the war been fought?

On 3 January 1948, Bevan offered his pledge: free healthcare for all, to be delivered on 5 July of that year. In a speech he reflected that ‘there is a school of thought, you know, that believes that if a thing is scarce, it ought to be dear … But this is not an orthodox government, and I am not an orthodox Minister of Health.’ It was an assessment shared by his most implacable opponents, the nation’s doctors, represented by the British Medical Association.