Honorary Proletarian

It will only last as long as there are folks left with the faith to fight for it – Nye Bevan

Sixty years ago today, every household in Britain got a leaflet from the Labour Government.  This leaflet explained that:

Your new National Health Service begins on 5th July.  What is it?  How do you get it?

It will provide you with all medical, dental and nursing care.  Everyone – rich or poor, man, woman or child – can use it or any part of it.  There are no charges, except for a few specific items.  There are no insurance qualifications.  But it is not a ‘charity’.  You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.

Until the 5th July 1948 there had been nothing worthy of the name of a health care system in Britain.  Doctors, chemists, hospitals and laboratories were privately owned and run, uncoordinated and for most of them patients had to pay.  Even the limited medical “insurance” scheme introduced by the Liberal Government of Lloyd George covered only workers who could afford to pay into it and not their families – so the poor health of working-class women was one of the worst aspects of gender inequality, and class discrimination began before birth.

All this was changed by a combination of events and people.  In 1945 the people of Britain, mainly the working class, determined to build a just societyafter six years of war, elected the Labour Government of Clement Attlee by a landslide.  In 1944 the Party Conference had voted for a policy of wholesale nationalisation that the right wing of the party had immediately condemned as sure to lose Labour the election.  Attlee had the vision, or perhaps just the political nous, to appoint as Secretary of State for Health Aneurin Bevan, a man that same right wing had spent most of the previous decade trying to expel.

The result was a comprehensive revolution in health care.  The statement quoted above doesn’t sound revolutionary to people who have grown up with the NHS, but it is.  There is no question here of “means testing” or even a “safety net” for people failed by capitalism.  The service is universal; and far from the rich getting undeserved benefit from (which is today’s usual “progressive” argument for means testing) they are paying for it through graduated general taxation, and not deriving any great benefit from it since they could afford health care already.  Neither is there any idea of “qualifying” for benefits by one’s actions, any of that division between the “deserving” and “undeserving” poor which is actually a vicious form of class discrimination (since the rich don’t have to be “deserving”).  Rather, everyone gives according to their means and receives according to their need.  If the capitalist class don’t like it they will be prosecuted for tax evasion.

Today, though, the NHS and the socialist principles embodies in it are under threat.  The attacks on the NHS perpetrated by the Tories have been perpetuated by a Labour Government.  Although this government has invested huge sums of money in the NHS, in contrast to Tory neglect, they have continued and even extended the creeping privatisation of health services the Tories planned and initiated.

“The NHS,” said Thatcher, “is safe in our hands” - but she struck the worst blow right at the start by compelling NHS institutions to function as if they were part of a capitalist “market”, even in relation to each other.  Since then the logic of this “market” has resulted in the introduction of private finance and private norms to more and more of the public health service.  The government insists that there is no danger to the public nature of the NHS, since “only” 8% of services involve private finance; but the NHS being the biggest employer in Europe, that 8% represents a huge field of play for profiteering scum, and that field is growing.

Government spending restrictions, based on “market” imperatives that insist on a predictable balance of income and outgoings and expenditure being set for each type of medical procedure, threaten the future of specialist units like the Nuffield Orthopaedic Hospital here in Oxford, where obviously a high proportion of procedures with many complications are carried out.  Similar market dogmatism has caused the decline in the number of NHS dentists.  The Department of Health restricted expenditure per procedure, and greedy dentists decided that rather than offer what they said was a second-rate service to everyone, they would offer a first-rate service to those who could afford to pay.  here i am afraid the government is to be condemned on two grounds – first for cutting services and then, having made that bad decision, for compounding their error by not compelling all dentists to accept it.

It is not scaremongering to say that the NHS faces the ultimate question.  With the real prospect that there might be a Tory government in a couple of years, a government committed to a Thatcherism of teeth and claws, no current promise of investment in the universal public service, or restriction on privatisation, can be guaranteed.  In such circumstances to play a game of public-private brinkmanship with the country’s most vital public service is nothing short of grossly irresponsible.  Ultimately, since a universal service cannot be profitable or anywhere near profitable – as amply demonstrated by the state of health care in Britain before 1948, and in the USA now – the involvement of profit-making corporations and, more generally, of “market” norms, threatens the very existence of the NHS.

As Nye Bevan rightly said, then, it is as necessary to fight for the NHS now as it was in 1948.  Thankfully there are many “folks left with the faith” to do so.  I’ve just come from an NHS birthday party organised by the Labour Lord Mayor of Oxford, Susanna Pressel, and the local branch of Keep Our NHS Public.  Attending were trade unionists from across the NHS who, whatever the cowardice of their leaders, are determined to fight for patients, fellow-workers and their own jobs; campaigners who have saved the Horton Hospital in nearby Banbury from the threat of closure; and others in solidarity.

There is a danger that people are so used to the NHS that they don’t notice any threat to it.  However, awareness of the threat is growing and campaigns to defend it are growing in step: thousands of people demonstrated in Banbury.  Ultimately we will save the NHS if we see it, and can make the labour movement and the public at large see it, not only as a great public asset to be kept out of rapacious hands, but also as a platform for even greater and more far-reaching change in the future.  The NHS is one of the few achievements of the 1945-51 Labour Government to remain more or less intact, and the commitment of NHS workers over the past sixty years and today is a great inspiration.  Nye Bevan, thinking of the workers’ self-organised health scheme in Tredegar, said he wanted to “Tredegarise” the whole health service of Britain.  Let us adopt as our ambition the “NHSisation” of the whole of society.