History of England 1-6

Moran wrote to Bevan, explaining the deeper causes of the BMA’s intransigence. ‘My dear Nye,’ he began. ‘The irrational fears of GPs [are] that one day you will turn them into salaried servants of the state.’ This, Bevan felt, could be addressed. He therefore presented an amendment on 7 April which ensured that GPs would never be civil servants or wage slaves without a new Act of Parliament. What was more, he promised that the GPs could join the new health service while maintaining their private practices, something he had learned from the Tredegar Association. The cynicism was as striking as the magnanimity. ‘I stuffed their mouths with gold,’ Bevan boasted. But the BMA, still confident of final victory, remained unbiddable.

In spite of growing scepticism in the press, on 12 April Bevan insisted that his health service would be launched on time. The government appealed again to the nation, this time via a press campaign. ‘Every forty minutes, a child dies of diphtheria’, it was emphasized. Twenty million people now signed up for the service. Within five weeks, 75 per cent of the adult population had put themselves down for the free healthcare promised.

On 4 May 1948, the BMA turned again to its members for support. Now, however, almost 40 per cent had changed their minds. The swing was by no means complete, but it was enough. And so, on 28 May, the BMA advised all its members to join the NHS. What seemed a remarkable capitulation carried a caveat: they called for a delay. This would have meant final defeat for Bevan, whose riposte was to point out that there would always be more demands and more delays. The reply worked admirably.

But the NHS was still far from ready. Moreover, in two years costs had almost doubled, to £180 million. Most of the 3,000 hospitals were crumbling; age and the Blitz had seen to that. In London, not one hospital was unscathed. Most worrying of all, with five weeks to go, 30,000 new nurses were needed. Another campaign was launched, revealing once again the Labour government’s readiness to adapt to new media, but the press resumed its attacks: ‘Free for All’ and ‘Stop this Bad Bill’ were among the milder headlines.

It was Sunday 4 July 1948 and the NHS was to be open for business on the following day. Yet Bevan chose this day to launch an attack on his political opponents so intemperate as to be self-defeating. All the resentments of the past few years inspired this otherwise generous man to describe the Tory party as ‘lower than vermin … They condemned millions of first-class people to semi-starvation.’ Why did Bevan launch his spectacular assault the day before the birth of the NHS? There was little in the way of calculation at work. In truth, while he spoke like a poet he thought like a child, with an immovable sense of right and wrong.

On the next day, the NHS was inaugurated. The event was signalled by the opening of the Trafford Park Hospital in Manchester. ‘It was like a wedding,’ remembered Mary Bane, a nurse. True to form, Bevan greeted everyone. He proclaimed that ‘we have been the dreamers, we have been the sufferers. Now we are the builders.’ Attlee himself, in a period of illness, refused a side ward, insisting that he should be treated like anyone else. Nurses would find him chatting happily with his fellow patients. A spirit of gratitude, so long dammed up, now gushed forth. Even administrators would be given little presents, as if they had wrought this miracle themselves. There was, of course, a huge backlog of diseases, phlegmatically borne for want of any alternative. Women came to their GPs with their uteruses turned inside out. Men had gone about their affairs with hernias ‘the size of balloons’.

All this came at a cost: 240 million prescriptions were filled out, a fourfold increase in two years. The budgetary caps were soon broken, and an upper limit of £170 million swelled to £352 million in the space of two years. A citizen would soon have to wait half a year to see an optician. Thirty-three million sets of false teeth were made in the first nine months, many of them for children. Bevan and others had imagined a decrease in the numbers of people using the NHS as the nation became healthier, but a different law applied: gas expands to fill the space available. As medicine developed and demand increased, so costs rose. But the effects of the new service could not be denied. Deaths from infectious diseases fell by over 80 per cent. For a while, the opposition remained unconvinced and unrepentant. Lord Horder spoke of ‘this temporary minister’ and predicted that the good old days of private practice would soon return. But the NHS remained, and its GPs remained its motor. The role of the doctor had come full circle: he was again the helper and healer.