Setting the Record Straight: Labour and the NHS

So, it’s the silly season again, and politicians are once more gripped by an irrational argument. No change there.

But for those of us who study history, the latest furore over the NHS is positively nauseating, with people apparently split into the camps of those who decry its very right to exist, and those who suddenly pretend they haven’t spent the last few years grumbling about how it’s in dire need of reform.

Part of this division is built upon a myth – a boil that needs to be lanced. We’re so used to Labour politicians churning out the line that Labour gave us the NHS, that we’ve begun to unthinkingly accept it. When Ian McCartney MP celebrated Labour’s centenary in 2006, he actually shed a tear for the NHS as Labour’s greatest triumph. Anyone familiar with 1940s history will tell you that this version of events is a cruel lie.

The NHS owes its existence to the climate of wartime British politics, not least the vastly expanded access to basic healthcare which came with conscription, and the subsequent rise in expectations. As Paul Addison outlined over 30 years ago in his landmark The Road to 1945, the wartime coalition of 1940-5 fostered a remarkable degree of consensus. In social policy, this resulted in the seminal 1942 report Social Insurance and Allied Services, chaired by the Liberal economist William Beveridge – better known as the Beveridge Report. In this, Beveridge set out a comprehensive state plan of social care. Section 19 of the report is the first public mention of a “National Health Service.”

The report was enormously influential, and what cannot be stressed enough is that in the subsequent 1945 general election, all three parties endorsed the Beveridge Report.

Revealingly, all three parties had NHS proposals in their 1945 manifestoes. The Conservatives actually had the longest section in their manifesto, pledging:

The health services of the country will be made available to all citizens. Everyone will contribute to the cost, and no one will be denied the attention, the treatment or the appliances he requires because he cannot afford them. We propose to create a comprehensive health service covering the whole range of medical treatment from the general practitioner to the specialist, and from the hospital to convalescence and rehabilitation

although they went on to envision it as encompassing voluntary hospitals and university medical research, as well as focussing on maternity care.

The Liberals had the shortest manifesto of the election, making just 20 points, but still placed health as a priority:

People cannot be happy unless they are healthy. The Liberal aim is a social policy which will help to conquer disease by prevention as well as cure, through good housing, improved nutrition, the lifting of strains and worries caused by fear of unemployment, and through intensified medical research. The Liberal Party’s detailed proposals for improved health services would leave patients free to choose their doctor, for the general practitioner is an invaluable asset in our social life.

and in typical Liberal style, they accordingly released a supplementary pamphlet giving detailed proposals for the practical implementation of such a scheme, which nobody read, but was then largely worked into law a year later.

The Labour party, on the other hand, was by far the most ambivalent of the three. It gave a fairly evasive pledge, envisioning the NHS as little more than an advisory body for healthier nutrition and medical research:

By good food and good homes, much avoidable ill-health can be prevented. In addition the best health services should be available free for all. Money must no longer be the passport to the best treatment.

In the new National Health Service there should be health centres where
the people may get the best that modern science can offer, more and better hospitals, and proper conditions for our doctors and nurses. More research is required into the causes of disease and the ways to prevent and cure it.

The point is that a Conservative post-war government under Churchill was fully signed up to introducing the NHS. A Liberal post-war government under Sinclair was fully signed up to introducing the NHS. The NHS was not Labour’s great achievement, it was an inescapable conclusion. And it was only the colossal Labour majority of 1945 which made it possible for Clement Attlee’s government to confidently embark on an NHS scheme that was deeply controversial among its own members.

The Labour party, despite its self-written mythology, was not even a dogged believer in socialism up until this point. Until the 1920s, most of its own MPs saw themselves primarily as workers’ and trade unions’ representatives, and the majority did not consider themselves to be socialists (indeed, with the Fabian Society originally within the Liberal tradition, far more Liberal MPs of the 1900s and 1910s considered themselves socialists than Labour or Lib-Lab MPs did). Furthermore, the Labour party was never particularly interested in social reform before the Beveridge report. Many Labour MPs actually opposed the first state pensions in the 1909 Peoples’ Budget because they thought they would get in the way of demands for wage increases. The Labour governments of 1924 and 1929-31 dismissed talk of such comprehensive extensions of the state as unaffordable, focussing instead on appeasing further trade union claims for wage rises until the Great Depression made that impossible. It wasn’t until a report commissioned by a Conservative-led coalition, and chaired by a Liberal economist, that the Labour party showed any serious inclination towards social reform, and only after the other two parties had embraced it.

If anything, the National Health Service Act 1946 is emblematic of something else – the Labour party’s struggle for a justification to exist in the modern age. Even as early as the 1940s, with the levelling of society during WWII, the justification for a purely class-based party came under question. Labour was in search of themes, and continued to be through much of the twentieth century. Thus we see the natural consequence today, with the farcical sight of Labour MPs wrapping themselves in the flag of the NHS, in historical paroxysms.

These exaggerated claims that the NHS owes its whole creation to the Labour party are only possible through the most colossal ignorance and misrepresentation of the past, of what was a cross-party consensus. The NHS was Britain’s triumph, not Labour’s.

Seth Thévoz is currently completing an MA in Modern History at King’s College London. He writes here in a personal capacity.

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30 Comments

  • Excellent article Seth.

  • Thanks, Seth. Best blog post I’ve read in a while, on any site.

  • Superb article. I echo the comment above; one of the best posts I’ve read in a long time. Thanks Seth

  • Peter Sloman 21st Aug '09 - 4:27pm

    This is certainly a much-needed riposte to the tendency of Labour politicians to claim exclusive parentage of the NHS. However, I think you overstate the degree of consensus in the field of health care during the 1940s.

    What is conspicuously absent from the 1945 Conservative manifesto is a commitment to make the new health service free to all citizens at the point of use. Given the prevailing scepticism of Tory backbenchers in the 1935 Parliament to the expansion of state welfare provision (including the Beveridge Report), it’s far from clear that a postwar Conservative government would have done more than continue existing trends towards the integration of health services under regional boards, and establish a (means-tested) right for the poorest citizens to receive treatment free of charge.

    A Liberal government during the late 1940s would have established something more closely resembling Aneurin Bevan’s NHS, providing treatment for all free at the point of use. But it is worth noting the voluntarist and decentralist tone of the policy paper Health for All, produced by a Liberal sub-committee in the summer of 1942 – that is, whilst the Beveridge Report was still being drafted. Whilst the state would fund the health services through general taxation, Health for All proposed that voluntary hospitals would remain independent, doctors would be able to combine NHS work with private practice, and patients would retain the right to choose their GP. As Elliott Dodds explained in Let’s Try Liberalism (1944), the Liberal policy was framed so that “the widest scope would be left for individual ability, experiment and choice” within the health service. A Liberal health service would probably have achieved similar – or better – outcomes for patients to that which Bevan created, but in structural terms it would not have been the same. Moreover, as with the Conservatives, it is possible that the Liberal commitment to universal free provision might have been whittled away in the context of postwar budgetary constraints.

    In short, health reform may have been inevitable at the end of the war, but the creation of the NHS as we have known it certainly was not: the system created in 1948 bore the unmistakable stamp of Aneurin Bevan’s socialism and of the Labour government’s willingness to prioritize health spending in a difficult budgetary environment. Whether this is the right model for health provision today, and whether Andy Burnham and his Labour colleagues are fit heirs of Bevan’s legacy, are other matters entirely.

  • And to echo much of what has been said above Seth: Excellent article.

  • Terry Gilbert 22nd Aug '09 - 12:35am

    It is always useful to have a reminder that Beveridge was a Liberal, and many Liberal ideas contributed to the NHS, but I feel this article is trying a wee bit too hard to denigrate Labour (who, btw, are one of our forerunner parties, via the SDP). Nye Bevan’s political achievement in out manouvring the vested interests in the medical profession was substantial, as Barack Obama’s current travails emphasise only too clearly.

  • Michael Bater 22nd Aug '09 - 6:16pm

    Dear Seth,

    For a person who studies history, I wonder who employs you; though I think it’s most likely The Fox Network, because you seem to follow their ‘fair & impartial,’ mantra, i.e. make everything up.

    You wrote:

    ‘The point is that a Conservative post-war government under Churchill was fully signed up to introducing the NHS.’

    They didn’t. The Churchill opposition voted against the setting up of the NHS 21 times, including the third reading.

    I don’t think it’s a cross-party consensus?

    Ever since it’s inception the conservatives have tried to dismantle it, with support from members of your won party & it’s previous incarnations, (as you seem to be a historian, research the ‘Orange Book.’)

    If you want to pass your MA, in modern history, it may be a good idea to DO SOME RESEARCH!

  • Michael Bater 22nd Aug '09 - 6:44pm

    Pete B it’s not about living in the past, it’s about learning from it. – BevaniteEllie Is correct Cameron is trying to show that new compassionate Conservatism ‘loves,’ the NHS, but once you scratch away the wallpaper, & look in the cracks, you can see that they still have the same ‘me first & fuck everyone else’ mentality they have always had.

  • Seth Thevoz 22nd Aug '09 - 7:28pm

    Many thanks for your comments.

    To respond to a few of the points raised:

    – As I mentioned in the piece, all three parties were completely agreed on some form of national health service. Peter is quite right to say that the Conservatives were conspicuously silent on whether it would be completely ‘free at the point of use’. But then the idea that this was ever delivered as a lasting legacy is an exaggerration as well – Bevan (and the young Harold Wilson) resigned from the government in 1950 in protest at the introduction of prescription charges. We may all agree that prescription charges were (and still are) a relatively small sum, but with their introduction by the same Labour government, the entire ‘free at the point of use’ principle was already hugely compromised.

    – Bevan can indeed be credited with the act in its final form, and as Frank has helpfully added, was influenced by the Tredegar scheme. However, the point that needs to be recognised is that the debate had moved on by the post-war era. It was not ‘should we have an NHS?’, but ‘what form should the new NHS take?’ I’m afraid the last couple of postings fall into the fallacy of mythologising the whole debate, and imagining it ran along the former lines, rather than the latter. I suppose it comes partly down to whether you believe the crucial years were c.1945-8 (when the NHS was implemented), or c.1940-4 (when the NHS was conceived, and its adoption widely accepted), as this piece makes a case for.

    – And this deification of Bevan – undoubtedly a man of principle – needs to recognise that many of the ‘special interests’ he fought off were as much in the Labour party as in the medical profession, i.e. the serious scepticism among trade unionists that an NHS would provide employers with an excuse to say they were overburdened, and could not afford further wage rises. You can choose to deify Bevan, or deify the Labour party, but not plausibly both, as the former’s triumph was partly over the latter.

    – As for the Conservatives voting against the NHS Bill multiple times, this is a bit of a non sequiteur. Like other twentieth century landslides of the left (1906-10, and 1997-2005), the ’45-’50 parliament was a bitterly partisan one – it even started off with Labour and Tory MPs singing ‘The Red Flag’ and ‘Rule Britannia’ to one another, and the newly-elected Tory MP Harry Legge-Bourke throwing a coin at Attlee! There was a deeply ingrained culture among the Tories (who had been used to landslide majorities of their own for the past 14 years) of launching ‘wrecking’ actions against *all* government initiatives, regardless of merit – Churchill argued this was the opposition’s constitutional role. I don’t personally buy this as a justification of what an opposition is there to do, but it was the rationale of the time for the Tories. If you read the policy papers of all three parties, you begin to realise how very similar their own constructive proposals actually were, and that they differed largely in nuance and emphasis.

    – As for raising the Tory cuts of the 1980s, that rather misses the whole point of the piece. Above, I have dealt with the birth of what we rightly call the ‘post-war consensus’, and how the NHS came out of that. The Thatcherite Conservatives of the 1980s were wholly committed to breaking up that post-war consensus in all its forms – which is partly why the SDP’s staunch defence of several of the institutions of the post-war consensus prompted the jibe from the Tories that the SDP stood for “Not a better tomorrow, but at least a better yesterday.”

    It would be an act of extreme ignorance to call the NHS a sole product of the Conservatives, or a sole product of the Liberals. Unfortunately, it seems to have become socially acceptable to say precisely this about Labour, despite it being palpably untrue. And I suspect the thought of yielding this argument absolutely terrifies the Labour party today, because in losing this, they would lose one of the landmark reasons they give to justify their existence.

  • Seth Thevoz 22nd Aug '09 - 7:52pm

    Incidentally, if anyone has some time on their hands and wants to look up the actual debates, they can be read at http://hansard.millbanksystems.com/search/“national%20health%20service%20bill”?year=1946

  • Good article Seth. I am reminded of how Nye Bevan compared the task of converting Labour’s leaders to the NHS Bill to the efforts of Sisyphus in Greek mythology, pushing a boulder up a hill, always to see it roll down again.

  • A great read Seth,

    while I agree with your article is historically correct in most areas I am afraid I cannot agree with your comments with regards to the actions of Churchill in opposition. Churchill personally called upon consultants of their time to vehemently oppose the introduction of the NHS. While it might be true that all parties agreed on some form of medical care for the Nation after the war it did not necessarily mean that the Tories in particular would have seen through a bill creating the NHS, had they won the election. The NHS is the greatest gift this country has been given, no matter who is given the deification for its creation. While it has lost its general direction somewhat due mainly because it has expanded into areas it was never intended for, such as cosmetic surgeries like varicose veins and tummy tucks, infertility treatments and various other types of surgical and medical procedures. These procedures would have been the responsibility of the person seeking that kind of treatment and would have been accessed privately.

    Thatcher created a market driven health service one of competing products, she along with her cronies wanted to dismantle the health service, she created highly paid managers who have been about as creative and as useful as a chocolate fireguard. The NHS would be simple to sort out it just needs someone with the courage to do it and return it to what it was created for in the first place, more than 75% of its costs are purely admin and that in-itself makes no sense at all.

  • Georgina Lansbury 15th Sep '12 - 7:39pm

    The Conservatives’ attitude towards the National Health Service (NHS) was ambiguous. While the political costs of attacking the service were too high to be seriously considered, the party was committed to tax cuts. In 1951, a committee on the economic situation identified the NHS as a key target for reductions in expenditure. The Chancellor, Richard ‘Rab’ Butler, recommended a one shilling prescription charge, a two pence increase in national insurance contributions, hospital ‘amenity’ charges and charges for dental treatment – or the suspension of the dental and ophthalmic services. Cabinet, however, was unwilling to sanction the suspension of services and subsequently dropped the proposed increase in contributions. The prescription charge and dental charges were incorporated into the National Health Service Act of 1952.

    that’s a quote from http://www.nationalarchives.gov.uk/cabinetpapers/themes/conservative-rule.htm.

    The Conservatives voted against the Socialist vision of the NHS three times. The NHS does belong to Labour, it was part of a Socialist ideal of the time, and that makes this not such a wonderful, insightful piece. Liberal voice? I think The Cam’s got your tongue .

  • Matthew Rubringer 7th Jun '15 - 5:57pm

    Labour’s large majority allowed them to push through the NHS plan that was controversial amongst the people that formed that majority itself….well that makes sense.

  • Dedrah Moss 27th Apr '17 - 1:30pm

    Well after reading the original post and most of the comments, all I have decided on is that it seems you can’t trust any party or believe their manifesto ,because once they get in power the always seem to go back on manifesto promises.all I know is the state of our local hospital and which parties have helped with out campaign, and who has totally ignored what is going on. So I will be voting on what I have seen with my own eyes and who has stood with us week after week come rain or come shine,to get our A&E open 24 hours a day.

  • Bernie Allan 4th Oct '17 - 12:17am

    I’ve read Seth’s section about Labour several times and find it impossible to match up his summary with the Labour manifesto quote. Is it just me?

    “The Labour party, on the other hand, was by far the most ambivalent of the three. It gave a fairly evasive pledge, envisioning the NHS as little more than an advisory body for healthier nutrition and medical research:

    By good food and good homes, much avoidable ill-health can be prevented. In addition the best health services should be available free for all. Money must no longer be the passport to the best treatment.

    In the new National Health Service there should be health centres where
    the people may get the best that modern science can offer, more and better hospitals, and proper conditions for our doctors and nurses. More research is required into the causes of disease and the ways to prevent and cure it.”

  • Richard Underhill 18th Jan '18 - 4:09pm

    Former PM and world war one leader David Lloyd George spoke against Neville Chamberlain in the ‘Norway’ debate. WSC offered DLG (aged 77) a job, despite political difficulties, but was refused. The US President required “an outstanding national figure and a statesman versed in every aspect of world politics”[Alone, page 452]. DLG was acceptable to FDR. “I was conscious that he had aged, even in the months since I asked him to join the War Cabinet” “and with regret, but also with conviction I abandoned my plan.”
    WSC had known Sinclair in WW1. He was included as Liberal leader.
    The film The Darkest Hour starts with Labour leader Clem Atlee calling for the resignation of Neville Chamberlain, forcefully expressing Labour’s opinion at that time, but Attlee [ISBN1 902301 70 6 Politicos 2000] did not say it in the Norway debate because he was on holiday. He did consult Labour’s NEC at Bournemouth conference, (knowing what they would say) and instructed the Parliamentary Labour Party to make the vote one of confidence, which they did.
    The general election of 1935 had produced a large majority of Conservative MPs, to which Attlee owed his leadership because most of Labours’ leaders had lost their seats.
    Attlee had a safe seat in Limehouse (London docklands, later heavily bombed).

  • Richard Underhill 19th Jan '18 - 9:38am

    In peacetime WSC offered a cabinet post to the Liberal leader, Clement Davies, but was refused because it would have meant the end of the Liberal Party.

  • Brilliant piece very well written. Unfortunately the current Labour leadership is only interested in using the NHS for his own agenda and scare mongering. It is all they have.

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