Why the NHS matters so much to so many

01.07.23

Philosophy Football's Mark Perryman celebrates 75 years of a nation being looked after 

5 July 1948 the National Health Service was born. The architects of this most magnificent endeavour, Labour firebrand socialist Aneurin Bevan, a sort of 1940s cross of Tony Benn and  Jeremy Corbyn, with archetypal  social democrat economist John Maynard Keynes and liberal reformer William Beveridge. A curious mixture, today we might call it a 'progressive alliance' in those days the 'popular front'. A politics of co-operation, extra-parliamentary as well as at Westminster, founded in the 1930s with anti-fascism the core. At home to stop in the streets Mosley's blackshirted British Union of Fascists, abroad to defend on the battlefield Republican Spain from Franco's fascists 

It is scarcely remarked upon by the cult of the Churchillian that in the year arguably Britain's greatest-ever wartime leader secured final victory against the Axis Powers of Nazi Germany, Fascist Italy and Imperial Japan Churchill led the Tories to one of their heaviest ever defeats. Churchill's much lesser-known deputy in the world War Two coalition government, Labour leader Clement Attlee captivated the electorate with his pledge to 'Win the Peace'.  Our allies, the USA had their new deal, the Soviet Union their five-year plan. Both in their (very) different ways an effort at a fundamental redefinition of politics and in the process attracting global popular support.  Now Britain was to have its own, and also different, go Attlee's post-war settlement was founded on five momentous changes. The Welfare state, nationalised public utilities, free, including university, education, full employment and the creation of a National Health Service. Campaign pledges, turned into institutional change once in office.  

Bevan summed up the scale of ambition and achievement beautifully:  " We have been the dreamers. We have been the sufferers. And now we are the builders." The NHS is widely regarded as the pinnacle of this shared purpose. So much so that for the intervening three-quarters of a century the NHS is often described as the closest the British have to a state religion. It is worth remembering therefore in all the hoo-hah of the anniversary that it was created in the teeth of the fiercest opposition from the Tories who described the NHS as nothing less than communism, while the main doctors' organisations resisted this most momentous change with a diehard defence of their previously over-privileged professional position. 

Labour's failure to find an effective response, to build a popular bloc in support of the new settlement, to be proud and public about the scale and consequences of what it was setting out do contributed to Churchill's comeback General Election win in 1951. Attlee would never lead Labour to victory again, Bevan became both a compromised and marginal figure. Yet what both had created, the ideas of Beveridge and Keynes, remained in place, largely untouched for the best part of 40 years.  The post war settlement transformed into a post war consensus, neatly encapsulated by a 1960s politics buzzword `Butskellism'  that signified the large scale agreement by the two leading figures of political renewal, Tory Rab Butler and Labour Hugh Gaitskell.    

All of this was to change in 1979 and Margaret Thatcher.  Not in one term, not by one leader not by one party, but all the core components of the post war settlement dismantled, never to be replaced.  Public utilities privatised under Thatcher none renationalised by Labour.  State schools handed over to the private sector masquerading as Academies, a device massively expanded by Blair. University tuition fees introduced by Major,  grants replaced by student loans by Blair, the cost of tripled by Cameron with the  support of Lib Dems, and as a result universities now entirely marketised. Full employment as government's first priority dropped by Thatcher, rates of poverty soared ever since.

So come next Wednesday a celebration or a wake for the NHS? In theory its founding principle, or to continue the state religion thesis, creed, remains intact. Providing care based on need free at the point of delivery. But visit any modern hospital and those bright shiny ideals are rusting away. Vast 'super ' hospitals replacing closed down local services, funded by Gordon Brown's flagship economic strategy,  PFI (Private Finance Initiative) leaving the NHS in ever-increasing debt to financiers for decades to come. Scanners and all sorts of other medical services operated by private companies to make a profit out of the NHS. Entire ambulance services operated by the private sector. Ditto hospitals' vital ancillary services. The nurses and doctors the nation clapped for through the Coronavirus crisis denied years' worth of wage rises just to keep pace with inflation forced to launch the biggest strike in the NHS 75 year history, for what? A living wage.

And there's an irony barely remarked upon with two 75th anniversaries taking place in the space of a few weeks.  First Windrush, second the NHS.  No institution in our society is as much loved as the NHS or so dependent, from top to bottom, on migrant labour. In all this feverish hatred of the very idea of immigration the NHS is testament to how immigration is a benefit to our society and economy, not a cost. For all of Labour's welcome talk of training thousands of new doctors and nurses - though the training infrastructure for such a ambition is almost entirely absent - it would be good if the fact the foundation, survival and future of the NHS are all impossible without immigration. 

We celebrate the NHS as a popular institution, one many of us could quite literally not live without. Precious, sometimes flawed, right now more vulnerable than at any point in its history. Rates of obesity at an all-time high, levels of physical participation at an all-time low, the vape replacing tobacco smoking with the same health dangers this entails, the scourge of gambling addiction and all manner of other versions of mental health problems, an ageing population with dependents who have neither the time or the money to provide the care previous generations gave. The idea of the 'Nanny State' has become much reviled but in the shadow of war this is precisely what the NHS and wider welfare state represented. A society that takes the responsibility of caring for all.  With apologies to Hattie Jacques not so much Carry on Doctor, Carry on Nanny. 

    The NHS 75th anniversary mug designed by Steve Bell is available from here  

 Mark Perryman is the co-founder of the self-styled 'sporting outfitters of distinction' aka Philosophy Football